Clinical Complexity in Pediatric Neuroimmune Disease

Pediatric neuroimmune disorders present a persistent clinical challenge: heterogeneous presentations, overlapping mimics and time-sensitive decisions that influence long-term neurologic outcomes. Conditions such as multiple sclerosis, transverse myelitis, MOGAD, autoimmune encephalitis and neuromyelitis optica spectrum disorders often emerge with rapidly evolving or nonspecific neurologic symptoms, making early differentiation difficult—even for experienced clinicians.

The Multiple Sclerosis and Neuroimmunology Center at Cincinnati Children’s was recently named a Center of Excellence in Rare Neuroimmune Disorders (CERND) by Siegel Rare Neuroimmune Association. For clinicians, this designation reflects demonstrated capability in addressing diagnostic uncertainty, coordination of complex multidisciplinary evaluation, and managing immunotherapy-driven care longitudinally.

“This designation highlights our expertise and multidisciplinary approach to caring for patients with neuroimmunologic diseases,” says Elizabeth Wilson, MD, a Cincinnati Children’s pediatric neuroimmunologist who specializes in treating demyelinating conditions. “It’s an acknowledgement of how we blend clinical care and advanced research to better understand these rare diseases, develop acute therapies and design symptom management strategies.”

Barriers to Timely Neuroimmune Diagnosis

Rare neuroimmune disorders place pressure on traditional care pathways. Patients often experience:

• Diagnostic uncertainty due to multifocal or nonspecific neurologic symptoms
• Delays in accessing advanced neuroimaging or specialized serologic testing
• Fragmented management when care spans neurology, rheumatology, ophthalmology, psychiatry and rehabilitation

These gaps can affect treatment timing, disease control and long-term outcomes. Cincinnati Children’s addresses these challenges through a coordinated neuroimmunology model designed to streamline evaluation and reduce handoffs between subspecialists.

By centralizing expertise and testing, the program helps clinicians move more efficiently from suspected inflammatory disease to confirmed diagnosis, treatment initiation and long-term management planning.

When Specialized Neuroimmunology Changes Management

Cincinnati Children’s provides capabilities that are not consistently available in general neurology or community settings, particularly for pediatric patients with rare or treatment-refractory neuroimmune disease.

Patients benefit from:

• Advanced diagnostic evaluation, including specialized neuroimaging, antibody testing and genetic assessment
• Multidisciplinary expertise in a single care plan, with close collaboration among neurology, rheumatology, neuro-ophthalmology, psychiatry, psychology, genetics, radiology and rehabilitation medicine
• Experience with pediatric use of immunotherapies, including agents more commonly prescribed in adult populations

“Our team is comfortable managing immunotherapies that require additional training and experience,” Wilson says. “That matters for children whose disease activity or course requires more than standard treatment approaches.”

Families also gain access to clinical trials and novel therapies for conditions such as pediatric multiple sclerosis and autoimmune encephalitis—options that might not be widely available elsewhere.

Defining Features of Comprehensive Neuroimmune Care Programs

Centers designated as CERNDs demonstrate the ability to deliver comprehensive care for complex neuroimmune disorders, including:

• Acute disseminated encephalomyelitis (ADEM)
• Acute flaccid myelitis (AFM)
• Myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD)
• Neuromyelitis optica spectrum disorder (NMOSD)
• Optic neuritis (ON)
• Transverse myelitis (TM)

To support these patients effectively, centers must bring together multidisciplinary teams that include:

• Neurologists with neuroimmunology training
• Neuro-ophthalmologists
• Neuropsychologists and psychiatrists
• Neuroradiologists
• Occupational therapists
• Physiatrists
• Physical therapists
• Social workers
• Registered dietitians
• Rehabilitation specialists
• Urologists

“Our team of specialists has great exposure to treating patients with neuroimmunological conditions,” Wilson says. “From delivering clinical care to helping patients transition to our exceptional rehab center—we partner to ensure every patient has access to the most appropriate treatment and services.”

Coordinated Multidisciplinary Neuroimmune Care

The Multiple Sclerosis and Neuroimmunology Center takes a coordinated approach to care, offering dedicated neuro-rheumatology and neuro-ophthalmology clinics, allowing patients to see multiple specialists in a single visit when clinically appropriate. Twice-monthly case conferences support collaborative treatment planning and ensure alignment across specialties.

“It’s a tailored approach based on the patient’s needs and which specialists they need to see,” Wilson says. “We do our best to schedule appointments back-to-back. I can see any neuroimmunology patient in my clinic and know they’ll be able to see the rheumatology, ophthalmology, psychology or another specialty area on the same day if they need it.”

Each clinic has a coordinator dedicated to helping neuroimmunology patients navigate their care. Coordinators schedule all subspecialty appointments, lab work, imaging scans and infusions. If needed, they help patients get insurance approval for necessary services.

Rehabilitation is also a significant part of the Multiple Sclerosis and Neuroimmunology Center. Inpatient rehab and outpatient services—provided through the Brain Health and Wellness Center—help boost patients’ long-term outcomes. These top-of-the-line programs deliver physical, occupational, and speech therapy to patients who have experienced disease-associated brain injury. And, to help children transition back to the classroom, school liaison professionals work with school officials to create accommodation plans.

Advanced Immunotherapy Management in Pediatric Neuroimmune Disease

There is no “one size fits all” treatment for neuroimmune conditions. Effectively controlling the disease and reducing symptoms often requires a multi-faceted approach. In many cases, those treatments include groundbreaking immunotherapies that aren’t available everywhere.

“One of the biggest benefits we offer to patients is access to neuroimmunologists who are comfortable prescribing immunotherapies,” Wilson says. “It requires additional training, and not all neurologists are comfortable recommending those treatment options. We’re not limited in that sense.”

In most cases, existing treatments, such as VYVGART Hytrulo® for chronic inflammatory demyelinating polyneuropathy or ENSPRYNG® (satralizumab-mwge) for NMOSD, are designed for adult patients. Thanks to their advanced training, Multiple Sclerosis and Neuroimmunology Center clinicians are uniquely positioned to assess these treatments. They can determine which ones might be best for pediatric patients on a case-by-case basis, safely expanding therapy options.

“Oftentimes, the right medications start in the adult world and trickle down to pediatrics,” Wilson says. “Having a niche specialization where we’re aware of what’s going on in the adult world lets us advocate for those medications. We have the comfort level to say we want to prescribe these medications for children and that we’ll be comfortable managing their care.”

Expanding Treatment Options Through Research

Through clinical trials, the Multiple Sclerosis and Neuroimmunology Center also gives patients access to the latest treatment options that may not yet be approved. For example, Cincinnati Children’s clinicians are part of the Extinguish Trial, an international study examining a new indication for the existing drug inebilizumab. This trial tests how well inebilizumab fares against the current standard-of-care for autoimmune encephalitis.

In a separate research effort, investigators are examining the effects of stroke in pediatric patients with lupus. They are also working with the Neuroimaging Research Center to apply advanced imaging techniques to better understand disease pathology in patients with multiple sclerosis.

The center earns the CERND designation by bringing sophisticated treatments and forward-thinking investigations together to seamlessly deliver the most advanced care for neuroimmune diseases.

“As a center with a multidisciplinary model, we are unique,” says Wilson. “Each of our specialists is an expert with neuroimmune conditions, and we’re at the forefront of novel treatments and innovative research for these diseases. We’re dedicated to maximizing access and providing the best, most up-to-date care.”

Referral Indications for Pediatric Neuroimmune Disease

Cincinnati Children’s welcomes referral for children with:

• Suspected or confirmed neuroimmune disease
• Acute neurologic decline or demyelinating events
• Optic neuritis or recurrent inflammatory episodes
• Unclear diagnoses requiring subspecialty evaluation
• Disease courses that are a typical, relapsing or treatment-resistant

As partners, the center provides rapid diagnostic clarification, coordinated subspecialty assessment, and access to advanced treatments and clinical trials. Care teams maintain communication with referring clinicians to support shared decision-making across the patient’s disease course.

Please contact the Multiple Sclerosis and Neuroimmunology Center at 513-636-4222 or refer a patient.

(Published March 2025)

Read More from Neurology and Neurosurgery