Aphasic status epilepticus preceding tumefactive left hemisphere lesion in anti-MOG antibody associated disease
Kazuto Katsuse1, Masanori Kurihara1, Yusuke Sugiyama1
1Department of Neurology, The University of Tokyo, Tokyo, Japan.
Introduction:
Anti-myelin oligodendrocyte glycoprotein (MOG) antibodies have recently been associated with epilepsy with FLAIR hyperintense cortical lesions on MRI. Association between anti-MOG antibodies and epilepsy without detectable structural brain lesion on MRI is unknown.
Case Report:
A 48-year-old right-handed man with a four-and-a-half year history of anti-MOG antibody associated demyelinating disease presented with persistent global aphasia. Brain MRI showed no new lesion or cortical lesion in the left hemisphere. Electroencephalogram, magnetoencephalography, and brain perfusion single-photon emission computed tomography suggested epileptic foci in the left temporal and parietal lobes, and the patient's aphasia transiently responded to intravenous diazepam, compatible with aphasic status epilepticus. Cerebrospinal fluid showed mildly elevated cell count and positive oligoclonal bands. The patient only partially responded to antiepileptic drugs but responded to steroid pulse therapy. Six months later, the patient again exhibited global aphasia. Brain MRI showed tumefactive white matter lesion in the left temporo-parietal lobes.
Conclusion:
Autoimmune epilepsy without obvious causative lesion on MRI can be seen in the course of anti-MOG antibody associated demyelinating disease. The subsequent emergence of tumefactive lesion closely located to the epileptic foci may suggest some association between autoimmune epilepsy and demyelinating lesions.
Insights
Autoimmune epilepsy can occur in anti-myelin oligodendrocyte glycoprotein (MOG) antibody disease, even without visible brain lesions on MRI. Later development of lesions near seizure foci suggests a link between demyelination and epilepsy.
Area of Science:
- Neuroimmunology
- Epileptology
- Neuroradiology
Background:
- Anti-myelin oligodendrocyte glycoprotein (MOG) antibodies are linked to epilepsy with MRI-visible lesions.
- The relationship between anti-MOG antibodies and epilepsy without detectable MRI lesions remains unclear.
Observation:
- A patient with anti-MOG antibody disease presented with global aphasia and no new MRI lesions.
- EEG, MEG, and SPECT indicated epileptic foci in the left temporal and parietal lobes.
- The patient responded to steroids, and later developed a tumefactive white matter lesion in the same region.
Findings:
- Autoimmune epilepsy can manifest in anti-MOG antibody disease without initial MRI-detectable lesions.
- The emergence of a tumefactive lesion near epileptic foci suggests a connection.
Implications:
- This case highlights autoimmune epilepsy as a potential manifestation of anti-MOG antibody disease.
- Further research is needed to understand the link between demyelinating lesions and epilepsy in MOGAD.
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