Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2021 Mar;42(3):847-855.
doi: 10.1007/s10072-020-04942-0. Epub 2021 Jan 7.

Clinical features and management of coexisting anti-N-methyl-D-aspartate receptor encephalitis and myelin oligodendrocyte glycoprotein antibody-associated encephalomyelitis: a case report and review of the literature

Di Nan #  1 , Ying Zhang #  1 , Jinming Han  1   2 , Tao Jin  3
Affiliations
Review

Clinical features and management of coexisting anti-N-methyl-D-aspartate receptor encephalitis and myelin oligodendrocyte glycoprotein antibody-associated encephalomyelitis: a case report and review of the literature

Di Nan et al. Neurol Sci. 2021 Mar.

Abstract

Background: Anti-N-methyl-D-aspartate (NMDA) receptor encephalitis is an autoimmune encephalitis caused by antibodies targeting the GluN1 subunit of NMDA receptors. Myelin oligodendrocyte glycoprotein (MOG) antibody disorders are now widely accepted as peculiar neuroimmunological diseases with specific clinical and pathological features. Some rare cases of overlapping anti-NMDA receptor encephalitis and MOG antibody-associated diseases have been reported, presenting complex clinical symptoms that make the disease more difficult to recognize.

Method: In accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines, the terms "NMDAR" and "MOG," "NMDAR" and "demyelination," and "MOG" and "encephalitis" were searched in PubMed. Clinical cases with dual-positive anti-NMDA cerebrospinal fluid receptors and MOG serum antibodies during the disease course were included in this study.

Results: A total of 25 patients were analyzed in this study. The age at onset ranged from 3 to 54 years. The median number of relapses was 2.8. Administration of intravenous methylprednisolone and immunoglobulin was the most widely used treatment strategy (19/25 patients). Second-line treatments such as administration of mycophenolate mofetil, rituximab, interferon-β, azathioprine, cyclophosphamide, and temozolomide were also reported, followed by good outcomes.

Conclusions: The rates of coexisting anti-NMDA receptor encephalitis and MOG antibody-associated encephalomyelitis may be underestimated. Clinical symptoms such as seizures and cognitive decline accompanied by atypical central nervous system demyelination serve as warning signs of possible coexisting anti-NMDA receptor encephalitis and MOG antibody-associated encephalomyelitis. These patients could achieve good outcomes under proper immunotherapies.

Keywords: Anti-NMDA receptor encephalitis; Antibody; MOG antibody–associated encephalomyelitis; Symptoms; Systematic review.

PubMed Disclaimer

References

    1. Brunner C, Lassmann H, Waehneldt TV, Matthieu JM, Linington C (1989) Differential ultrastructural localization of myelin basic protein, myelin/oligodendroglial glycoprotein, and 2′,3′-cyclic nucleotide 3′-phosphodiesterase in the CNS of adult rats. J Neurochem 52:296–304. https://doi.org/10.1111/j.1471-4159.1989.tb10930.x - DOI - PubMed
    1. Johns TG, Bernard CC (1999) The structure and function of myelin oligodendrocyte glycoprotein. J Neurochem 72:1–9. https://doi.org/10.1046/j.1471-4159.1999.0720001.x - DOI - PubMed
    1. Pittock SJ, Reindl M, Achenbach S, Berger T, Bruck W, Konig F, Morales Y, Lassmann H, Bryant S, Moore SB, Keegan BM, Lucchinetti CF (2007) Myelin oligodendrocyte glycoprotein antibodies in pathologically proven multiple sclerosis: frequency, stability and clinicopathologic correlations. Mult Scler 13:7–16. https://doi.org/10.1177/1352458506072189 - DOI - PubMed
    1. Pröbstel AK, Dornmair K, Bittner R, Sperl P, Jenne D, Magalhaes S, Villalobos A, Breithaupt C, Weissert R, Jacob U, Krumbholz M, Kuempfel T, Blaschek A, Stark W, Gärtner J, Pohl D, Rostasy K, Weber F, Forne I, Khademi M, Olsson T, Brilot F, Tantsis E, Dale RC, Wekerle H, Hohlfeld R, Banwell B, Bar-Or A, Meinl E, Derfuss T (2011) Antibodies to MOG are transient in childhood acute disseminated encephalomyelitis. Neurology 77:580–588. https://doi.org/10.1212/WNL.0b013e318228c0b1 - DOI - PubMed
    1. Wynford-Thomas R, Jacob A, Tomassini V (2019) Neurological update: MOG antibody disease. J Neurol 266:1280–1286. https://doi.org/10.1007/s00415-018-9122-2 - DOI - PubMed

Substances

LinkOut - more resources