3.4 Treatment and outcomes
We performed long-term observation for those patients diagnosed with
MOGAD overlapping with NMDAR encephalitis. The follow-up duration ranged
from 8 to 56 months, with a median time of 25.4 months. Since the
initial diagnosis, all patients received first-line immunotherapy,
including intravenous methylprednisolone (IVMP, 1000mg/d) (n=8) and
intravenous immunoglobulins (IVIG, 0.4kg/mg/d) (n=6). One patient (pat
2) discontinued IVMP owing to side effects (gastrointestinal bleeding)
and received rituximab for long-term immunotherapy. Seven patients
(70%) remarkably benefited from first-line therapy with
improved clinical and radiological
outcomes. All patients received normalized long-term
immunosuppressive treatments, such
as azathioprine (n=9), mycophenolate mofetil (n=1), rituximab (n=1), to
avoid relapse (Table-1). However, 10 patients (100%) experienced one or
two relapses by follow-up. The median interval between disease onset and
the first relapse episode was 6.7 months (range: 2–14). When disease
relapsing, the patients underwent a new round of first-line
immunotherapy at acute phase, then continuing or changing their
immunosuppressants. Four of them increased dosage of azathioprine (pat
1, 3-5), and six of them altered immunosuppressive regimen (pat 2,
6-10). Administration of immunosuppressants and drug dosages were
detailed in Table-1. Eventually, the patients did not develop the next
relapse at the last follow-up.