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Clinical analysis of MOG antibody-associated disease overlapped with anti-NMDA receptor encephalitis: a long-term retrospective study
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  • Tianjiao Duan,
  • Song Ouyang,
  • Zhaolan Hu,
  • Qiuming Zeng,
  • Weifan Yin
Tianjiao Duan
The Second Xiangya Hospital of Central South University
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Song Ouyang
the affiliated Changsha Hospital of Xiangya School of Medicine, Central South Universityof Xiangya School of Medicine, Central South University
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Zhaolan Hu
The Second Xiangya Hospital of Central South University
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Qiuming Zeng
Xiangya Hospital Central South University
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Weifan Yin
The Second Xiangya Hospital of Central South University

Corresponding Author:[email protected]

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Abstract Objective: To summarize the clinical characteristics, radiological features, treatments, and prognosis of patients with myelin oligodendrocyte glycoprotein (MOG) antibody associated disease (MOGAD) overlapped with NMDA receptor (NMDAR) encephalitis. Methods: We retrospectively analyzed patients who exhibited dual positivity for MOG antibodies and NMDAR antibodies in serum/CSF from Jan 2018 to Jun 2023 Results: Ten patients with MOGAD and NMDAR encephalitis were enrolled. The median age of initial attacks was 23 (range: 10-43) years old. Common symptoms were cortical encephalopathies (8/10), focal neurological deficits (4/10), as well as other presentations including headache, fever, optic neuritis, and transverse myelitis. CSF pleocytosis was general (9/10, median 63.9 cells/μl). Lesions on brain MRI included brainstem (37.5%), cerebral cortex (33.3%), basal ganglia (25.0%), hippocampus (20.8%). The average follow-up duration was 25.4 months. 10/10 patients developed more than one relapse attacks, with MOG positivity before (10%), simultaneous (40%) or after anti-NMDAR encephalitis (50%). Most patients (7/10) had good response to first-line therapy, but experienced next relapse with an average interval of 6.7 (range: 2-14) months. We conducted initial analysis of lymphocyte subsets in these patients, which revealed CD3+ and CD4+ T cells increased after immunosuppressants medication (p < 0.01 and p < 0.05, respectively). Conclusion: MOGAD overlapping with NMDAR encephalitis presents a distinct clinical phenotype which differs from either MOGAD or NMDAR encephalitis. Brainstem in combination with cortical lesions might be warning signs for this overlapping syndrome. Due to the high recurrent rates, we recommend early diagnosis and timely treatment with high-efficiency immunosuppressants at onset.
29 Feb 2024Submitted to European Journal of Neuroscience
01 Mar 2024Assigned to Editor
01 Mar 2024Submission Checks Completed
01 Mar 2024Review(s) Completed, Editorial Evaluation Pending
02 Mar 2024Reviewer(s) Assigned