Intravenous immunoglobulins (IVIG) and plasmapheresis constitute second-line therapies in case of insufficient response to IVMP. In the acute attack, intravenous methylprednisolone (IVMP) leads to a favourable outcome in the majority of patients and can be followed by tapering of oral steroids up to a maximum of three months to maintain the benefit of acute treatment by suppressing disease activity. Therefore, this part of the Paediatric European Collaborative Consensus attempts to provide recommendations for acute and maintenance therapy based on clinical experience and evidence available from mainly retrospective studies. Currently used acute and maintenance treatment regimens are derived from other demyelinating central nervous system diseases and are mostly centre-specific. However, there is still lack of evidence-based treatment protocols for acute attacks and children with a relapsing course of the disease. In recent years, the understanding about the different clinical phenotypes, diagnostic and prognostic factors of myelin oligodendrocyte glycoprotein-antibody-associated disorders (MOGAD) has significantly increased. 17 Department of Neurology, Erasmus Medical Center, Rotterdam, the Netherlands.16 Department of Paediatric Neurology, Assistance Publique-Hôpitaux de Paris, University Hospitals Paris-Saclay, Bicêtre Hospital and Faculty of Medicine, Paris-Saclay University, Le Kremlin Bicêtre, France French Reference Network of Rare Inflammatory Brain and Spinal Diseases, Le Kremlin Bicêtre, France and European Reference Network-RITA.15 Department of Paediatric Neurology, Children's Hospital Datteln, Witten/Herdecke University, Datteln, Germany.14 Neuroimmunology Program, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic, Universitat de Barcelona, Barcelona, Spain Paediatric Neuroimmunology Unit, Neurology Department, Sant Joan de Déu (SJD) Children's Hospital, University of Barcelona, Barcelona, Spain.13 Neuropaediatric Unit, Karolinska University Hospital, Sweden.12 Children's Neurosciences, Evelina London Children's Hospital at Guy's and St Thomas' National Health Service Foundation Trust, London, Faculty of Life Sciences and Medicine, Kings College Hospital, London, UK.11 Department of Paediatric Neurology, Birmingham Children's Hospital, Birmingham, UK.10 Department of Paediatric Neurology, Great Ormond Street Hospital for Children, London, UK.9 Department of Neuroinflammation, Queen Square Multiple Sclerosis Centre, UCL Institute of Neurology / Department of Paediatric Neurology, Great Ormond Street Hospital for Children, London, UK.8 Department of Neurology and Regional Multiple Sclerosis Centre, University Hospital San Luigi Gonzaga, Orbassano, Italy.7 Paediatric Radiology Department, Bicêtre Hospital, Assistance Publique-Hôpitaux de Paris, University Hospitals Paris-Saclay, Bicêtre Hospital and Faculty of Medicine, Paris-Saclay University, Le Kremlin Bicêtre, France.6 Department of Paediatric Neurology, Assistance Publique-Hôpitaux de Paris, University Hospitals Paris-Saclay, Bicêtre Hospital and Faculty of Medicine, Paris-Saclay University, Le Kremlin Bicêtre, France.5 Department of Paediatrics and Adolescent Medicine, Division of Paediatric Neurology, Medical University of Vienna, Austria. 4 Department of Neurology, Charité - Universitätsmedizin Berlin / Berlin School of Mind and Brain, Humboldt-Universität zu Berlin, Germany.3 Department of Paediatrics, Division of Paediatric Neurology, Medical University of Innsbruck, Austria.Electronic address: 2 Department of Paediatrics, Klinikum Stuttgart/Olgahospital, Stuttgart, Germany. 1 Department of Neurology, Erasmus Medical Center, Rotterdam, the Netherlands.
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