Clinical and radiological spectrum of anti-myelin oligodendrocyte glycoprotein (MOG) antibody encephalitis: single-center observational study

Salunkhe, Manish; Gupta, Pranjal; Singh, Rajesh; Tayade, Kamalesh; Goel, Vinay; Agarwal, Ayush; Das, Animesh; Elavarasi, Arunmozhimaran; Pandit, Awadh Kishor; Vibha, Deepti; Garg, Ajay; Sebastian, Leve Joseph Devarajan; Bhatia, Rohit; Tripathi, Manjari; Gaikwad, Shailesh; Srivastava, MVPadma

doi:10.1007/s10072-023-06686-z

Cited by 6 publications

(6 citation statements)

References 24 publications

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“…Following the Graus criteria ( 8 ), the antibody assay was repeated, yielding the same result. Additional CSF changes, such as increased protein levels and pleocytosis, were observed in most of the described patients, further supporting the diagnosis ( 20 ). The EEG is not included in the diagnostic criteria, since there are no specific changes in the recording.…”

Section: Discussionsupporting

confidence: 70%

“…These findings are consistent with a recent study by Orozco et al (19), which demonstrated that cognitive and psychiatric symptoms were prevalent in the majority of patients with AE. Moreover, the presence of focal symptoms has also been reported in patients with encephalitis (20). The brain MRI played a crucial role in establishing the diagnosis.…”

Section: Discussionmentioning

confidence: 98%

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The MOG antibody associated encephalitis preceded by COVID-19 infection; a case study and systematic review of the literature

et al. 2023

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BackgroundNew neurological complications of COVID-19 infection have been reported in recent research. Among them, the spectrum of anti-MOG positive diseases, defined as anti-MOG antibody associated disease (MOGAD), is distinguished, which can manifest as optic neuritis, myelitis, or various forms of encephalitis (MOGAE).Materials and methodsThis study reports a new case of MOGAE following SARS-CoV-2 infection. A literature review of other MOGAE cases associated with COVID-19 infection was conducted and summarized.ResultsA 60-year-old male patient, who had previously been infected with COVID-19, was admitted to the Neurology Department with a rapidly progressive deterioration of his cognitive functions that lasted for about 3 months. On neurological examination, the Mini-Mental State Examination (MMSE) score was 17, which further deteriorated to 13. In addition, central paresis of the right VIIth nerve and pyramidal hemiparesis on the right side were noted. The MRI of the brain showed multiple hyperintense lesions. The CSF examination revealed an elevated total protein level with a normal cell count, and serum showed a positive finding of anti-MOG antibodies. Taking into account all the information, the diagnosis of MOGAE, following COVID-19 infection, was made. A total of 9 similar cases of MOGAE associated with SARS-CoV-2 infection were identified in the available literature. Among them 2 cases presented progressive cognitive dysfunction and another 5 altered mental status. The most frequently described MRI changes were hyperintense lesions located cortically and/or subcortically. Anti-MOG antibodies were positive in all patients. In 5 cases they were detected only in serum, in 2 cases in serum and CSF, and in 2 cases the origin was not reported.ConclusionThe reported cases of MOGAE following COVID-19 infection suggest an increasing new clinical problem, and show an association between COVID-19 and MOGADs.

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Section: Discussionsupporting

confidence: 70%

Section: Discussionmentioning

confidence: 98%

The MOG antibody associated encephalitis preceded by COVID-19 infection; a case study and systematic review of the literature

et al. 2023

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“…One example of successful expansion of the phenotype is cerebral cortical encephalitis which is often associated with high titers and often other core demyelinating events typical of MOGAD. 15 , 16 In our study, patients with low titers in the true‐positive cohort had supportive clinical or radiological features as outlined in the expert consensus diagnostic criteria thereby fulfilling the diagnosis of MOGAD. The false‐positive cohort did not have either the core clinical CNS demyelinating or supportive clinical/radiological features.…”

Section: Discussionsupporting

confidence: 60%

“…Expansion of MOGAD phenotype should consider the MOG‐IgG titers and the presence of other typical manifestations of MOGAD. One example of successful expansion of the phenotype is cerebral cortical encephalitis which is often associated with high titers and often other core demyelinating events typical of MOGAD 15,16 . In our study, patients with low titers in the true‐positive cohort had supportive clinical or radiological features as outlined in the expert consensus diagnostic criteria thereby fulfilling the diagnosis of MOGAD.…”

Section: Discussionmentioning

confidence: 52%

Peripheral nervous system manifestations of MOG antibody associated disease

Gupta,

Paul,

Redenbaugh

et al. 2024

Ann Clin Transl Neurol

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Recent studies have reported the involvement of peripheral nervous system (PNS) in association with MOG‐IgG, including isolated neuropathies. In this retrospective study we characterized the PNS involvement in MOG antibody associated disease (MOGAD). Six out of 215 MOGAD patients had PNS involvement (all polyradiculopathy) that occurred concurrently with a CNS demyelinating episode. We also demonstrated MOG expression in healthy human controls' proximal nerve root. Nine patients with true‐positive MOG‐IgG1 had PNS involvement temporally unrelated to a CNS demyelinating event. All these patients had an alternate etiology of PNS involvement. Isolated peripheral neuropathy is not a feature of MOGAD, but inflammatory nerve root involvement can occur concurrently with CNS demyelinating events.

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“…TDL were originally associated with presentations in patients with multiple sclerosis 3 . However, various etiologies underlying TDL formation have been identified, encompassing conditions such as acute disseminated encephalomyelitis 4 , 5 , neuromyelitis optica spectrum disorder (NMOSD) 6 , 7 , myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) 8 , MS variants (namely Baló concentric sclerosis 9 , 10 , myelinoclastic diffuse sclerosis or Schilder’s disease 11 , and Marburg’s acute MS 12 ), and autoimmune neurological disorders such as Behçet disease 13 and neurosarcoidosis 14 . Moreover, TDL may result from infectious processes 15 , 16 , certain medications 17 , 18 , or occur in isolation, devoid of concomitant demyelinating pathologies.…”

Section: Introductionmentioning

confidence: 99%

Tumefactive demyelinating lesions: a retrospective cohort study in Thailand

Ongphichetmetha,

Aungsumart,

Siritho

et al. 2024

Sci Rep

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Tumefactive demyelinating lesions (TDL), characterized by large (≥ 2 cm) demyelinating lesions mimicking tumors, are a rare manifestation of the central nervous system inflammatory demyelinating diseases (CNS-IDD). Distinguishing TDL from other brain lesions can be challenging, often necessitating biopsy or advanced diagnostics. The natural history of TDL varies among races. This study aimed to assess demographics, clinical and radiological features, laboratory findings, management, and outcomes of Thai patients with TDL. We retrospectively reviewed records of twenty-six patients with TDL from the Multiple Sclerosis and Related Disorders registry from two tertiary medical centers. Among 1102 CNS-IDD patients, 26 (2.4%) had TDL. The median age at TDLs onset was 34.5 years (range 17–75); 69.2% were female. Over 70% manifested TDL as their initial CNS-IDD presentation. Common presenting symptoms included motor deficits, sensory disturbances, and cognitive problems. About two-fifths exhibited multiple lesions, most frequently in the frontoparietal region (46.2%). Half of the patients showed an incomplete ring on post-contrast T1-weighted imaging, with peripheral diffusion-weighted imaging restriction in twenty-one patients. T2-hypointense rims were present in thirteen (56.5%) patients. Brain biopsy was performed in 12 cases (46.1%). Serum aquaporin-4 immunoglobulin was positive in 16.7% of tested (4/24) cases. Serum myelin oligodendrocyte glycoprotein immunoglobulin was negative in all thirteen patients tested. Twenty patients (76.9%) received intravenous corticosteroids for TDL attacks. After the median follow-up period of 48 months (range 6–300), 23.1% experienced CNS-IDD relapses. Median Expanded Disability Status Scale at TDL diagnosis was 4.3 (range 0.0–9.5), and improved to 3.0 (range 0.0–10.0) at the last follow-up. This study suggested that TDL were rare among Thai CNS-IDD patients, frequently presenting as a monophasic condition with a favorable outcome.

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Clinical and radiological spectrum of anti-myelin oligodendrocyte glycoprotein (MOG) antibody encephalitis: single-center observational study

Cited by 6 publications

References 24 publications

The MOG antibody associated encephalitis preceded by COVID-19 infection; a case study and systematic review of the literature

The MOG antibody associated encephalitis preceded by COVID-19 infection; a case study and systematic review of the literature

Peripheral nervous system manifestations of MOG antibody associated disease

Tumefactive demyelinating lesions: a retrospective cohort study in Thailand

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