Applying neuroautoimmune expertise to children

Jan. 30, 2026

Although rare, pediatric neuroautoimmune diseases can have devastating effects. As a renowned center for neuroautoimmune diseases, Mayo Clinic has expertise and experience with managing these conditions in children. Accurate diagnosis can be challenging.

"Pediatric neuroautoimmune disease is a spectrum of disorders, from mild symptoms to severe weakness, numbness and psychiatric disease. When children present with these symptoms, the question is: Is autoimmune disease really the root cause?" says Jan-Mendelt Tillema, M.D., a pediatric neurologist at Mayo Clinic in Rochester, Minnesota.

Mayo Clinic neurologists have access to innovative antibody testing for pediatric central nervous system disorders. "These tests are less frequently performed. Our approach focuses on identifying particles that are not typically considered in standard testing procedures," Dr. Tillema says. In addition, Mayo Clinic Children's has pediatric neurosurgeons who can perform biopsies if needed to help determine the cause of inflammation.

Precise diagnosis is key to guiding optimal treatment. "Timely and accurate diagnosis is especially important with very aggressive disease because it can be highly destructive early on," Dr. Tillema says.

Mayo Clinic has a specialized Pediatric Multiple Sclerosis (MS) Center, with multidisciplinary staff devoted to caring for children with MS and other demyelinating conditions. The center is recognized as a Pediatric Network MS Center by the National Multiple Sclerosis Society.

Multidisciplinary approach

The records of children referred to Mayo Clinic with suspected neuroautoimmune disease are thoroughly reviewed before the children arrive. Those reviews help determine which clinicians need to be involved in care. Many patients see specialists in Psychiatry and Psychology. A rheumatologist is consulted if an autoimmune reaction outside the central nervous system is suspected. Mayo Clinic pediatric neurologists also work closely — and share an office hallway — with the pediatric rehabilitation team, which is usually involved in this care.

The lack of neuroautoimmune medications approved for use in children is a major challenge. "For pediatric multiple sclerosis, we currently have one medication approved by the Food and Drug Administration for patients under age 18 — compared with almost 20 FDA-approved medications in the adult world," Dr. Tillema says. He notes that Mayo Clinic specialists have the expertise needed to adapt these Food and Drug Administration (FDA)-approved treatments for use in select younger patients.

Mayo Clinic physician-scientists also are working to find new monoclonal antibody therapies for pediatric autoimmune disease. Mayo Clinic participates in the Network for Excellence in Neuroscience Clinical Trial (NeuroNEXT) infrastructure, which is supported by the National Institute of Neurological Disorders and Stroke. One NeuroNEXT effort — known as the ExTINGUISH trial — is testing the safety and efficacy of inebilizumab for the treatment of N-methyl-d-aspartate receptor (NMDAR) encephalitis in adults and children ages 12 and older. A separate monoclonal antibody study is evaluating satralizumab for the treatment of myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) in adults and children ages 12 and older.

People with neuroautoimmune disease require lifelong care. At Mayo Clinic, pediatric patients can transition seamlessly to adult care. "We often work closely with referring physicians to provide the long-term care that these patients need," Dr. Tillema says.

"For many families that come to Mayo Clinic, it's been a long journey to determine what is going on," Dr. Tillema says. "Our goal is to provide answers whenever we can."