Ocular flutter as presenting manifestation of pediatric MOG antibody–associated demyelination: A case report

Abstract

A 13-year-old girl presented with a 5-day history of oscillopsia. On examination, ocular flutter and mild cerebellar signs were found. Brain magnetic resonance imaging (MRI) revealed four periventricular and subcortical non-enhancing lesions. Cerebrospinal fluid (CSF) oligoclonal bands were negative. Neuroblastoma or other malignancies were not found. She responded well to a corticosteroid–intravenous immunoglobulin (IVIG) combination and remained symptom-free for 3 years until presenting again with isolated ocular flutter. Brain MRI at this time remained atypical for classic multiple sclerosis (MS) with a predominance of juxtacortical demyelinating lesions. CSF was positive for oligoclonal bands. Serum myelin oligodendrocyte glycoprotein (MOG) antibodies were present. Ocular flutter can be the presenting feature of MOG antibody–associated pediatric demyelination.

The diagnosis of myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) in children

“…Although the most recent International MOGAD Panel has defined the typical clinical presentations used in the diagnosis of MOGAD as discussed above, the clinical phenotypic spectrum of MOGAD is still expanding with the widespread availability of anti-MOG-IgG testing using fixed or live CBAs and increased awareness of MOGAD, such as leukodystrophy-like phenotype [18], isolated seizures [39], ocular flutter [40], CNS vasculitis [41], cranial neuropathies [42], or intracranial hypertension [43] (Table 1). A relatively rare clinical presentation of MOGAD is encephalitis, which accounts for 7-9% of all non-ADEM autoimmune encephalitis in children [15,51].…”