720 - Agitation in Pediatric MOGAD is an Under Recognized Disease Sequalae

We present the case of a 3 year old boy admitted for fever and altered mental status and a 3 year old female admitted for altered mental status and acute respiratory distress. Both had recent diagnosis of strep pharyngitis.  After work up including MRI both subsequently diagnosed with antibody positive MOGAD.


Case Description:

3 year old male and 3 year old female were both admitted for altered mental status. Both underwent extensive medical work up. Both were subsequently diagnosed with anti-body MOGAD. Additionally, both of their hospital stays were complicated by agitation. These two patients ultimately had improvement of agitation with initiation of clonidine.


Discussions:

Altered mental status in pediatric MOGAD is classically associated with somnolence and lethargy in acute stages. In chronic disease, pediatric MOGAD is associated with increased rates of anxiety, depression and several neuropsychological impairments including: intellectual functioning, memory, processing speed, and working memory.  However, agitation remains an under recognized phenomenon of the disease process. In the above cases, we treated two children with MOGAD with clonidine for agitation with significant improvement of agitation in both cases. 


Conclusions:

Agitation in pediatric MOGAD is under-recognized. While managing children with MOGAD, it is important to assess patients for potential agitation. However, assessment of agitation in pediatric patients remains challenging. We propose, providers complete in-depth histories of the patient’s behavior before and after hospitalization and discuss potential signs of agitation such as irritability and restlessness with caregivers and with patient staff. Diagnosing agitation in pediatric MOGAD patients allows providers to better identify treatable causes of altered mental status in this disease process.