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Comparison of myelin oligodendrocyte glycoprotein (MOG)-antibody disease and AQP4-IgG-positive neuromyelitis optica spectrum disorder (NMOSD) when they co-exist with anti-NMDA (N-methyl-D-aspartate) receptor encephalitis

Published:January 17, 2018DOI:https://doi.org/10.1016/j.msard.2018.01.007

      Highlights

      • Both MOG-ab disease and NMOSD can co-exist NMDARe.
      • MOG-ab disease more commonly co-exist NMDARe than NMOSD.
      • When co-existing NMDARe, MOG-ab disease responds better to steroids/IVIG than NMOSD.

      Abstract

      Background

      Myelin oligodendrocyte glycoprotein (MOG)-antibody (ab) disease and AQP4-IgG-positive neuromyelitis optica spectrum disorder (NMOSD) can co-exist with anti-NMDA (N-methyl-D-aspartate) receptor encephalitis (NMDARe).

      Objectives

      To characterize MOG-ab disease and AQP4-IgG-positive NMOSD during NMDARe.

      Methods

      We analyzed all the patients with overlapping MOG-ab disease and NMDARe (MNOS) and patients with AQP4-IgG-positive NMOSD and NMDARe (ANOS) in our hospital and compared those data with data from systematically review of previously published reports.

      Results

      In our cohorts, 11.9% patients with MOG-ab disease and 0.6% patients with NMOSD had overlapping NMDARe (P < 0.01). After treatment with steroids and/or intravenous immunoglobulin (IVIg), the median modified Rankin Scale (mRS) of the MNOS group decreased significantly during attacks associated with or without NMDARe (P < 0.01 for both), while that of the ANOS group did not (attack: P < 0.05; attack associated with NMDARe: P > 0.05). Analyzed together with previously reported cases, 6% patients with MNOS and 40% patients with ANOS also used rituximab or cyclophosphamide after steroids and/or IVIg (P < 0.05) during attacks associated with NMDARe.

      Conclusion

      Compared with NMOSD, MOG-ab disease may more commonly co-exist with NMDARe. MNOS patients respond better to steroids and IVIg than do ANOS patients during attacks associated with NMDARe.

      Abbreviations:

      ab (antibody), ANOS (the overlapping syndrome of AQP4-IgG-positive NMOSD and NMDARe), AQP4 (aquaporin-4), CBAs (cell-based assays), CNS (central nervous system), CSF (cerebrospinal fluid), EDSS (Expanded isability Status Scale), IgG (immunoglobulin G), IIFT (immune-fluorescence test), MNOS (the overlapping syndrome of MOG-ab disease and NMDARe), mRS (modified Rankin Scale), MOG (myelin oligodendrocyte glycoprotein), MRI (magnetic resonance imaging), MS (multiple sclerosis), NMDA (N-methyl-D-aspartate), NMDARe (NMDA receptor encephalitis), NMOSD (neuromyelitis optica spectrum disorder)

      Keywords

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