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.