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FLAMES with Elevated Myelin Basic Protein Followed by Myelitis

Hiroyuki Hokama1, Yuki Sakamoto1, Toshiyuki Hayashi1

  • 1Department of Neurology, Graduate School of Medicine, Nippon Medical School, Japan.

Internal Medicine (Tokyo, Japan)
|May 8, 2022
PubMed

Insights

This study investigates anti-myelin oligodendrocyte glycoprotein (MOG)-associated encephalitis with seizures (FLAMES), revealing potential demyelination alongside inflammation. Elevated myelin basic protein in CSF suggests this dual pathology in FLAMES patients.

Area of Science:

  • Neuroimmunology
  • Neurology
  • Neuroinflammation

Background:

  • The underlying mechanisms of unilateral cortical lesions in anti-myelin oligodendrocyte glycoprotein (MOG)-associated encephalitis with seizures (FLAMES) remain poorly understood.
  • FLAMES is an inflammatory neurological condition characterized by seizures and specific brain imaging findings.

Observation:

  • A 26-year-old male presented with seizures and unilateral cortical FLAIR hyperintense lesions.
  • Cerebrospinal fluid (CSF) analysis revealed elevated myelin basic protein (MBP) and detected MOG antibodies.
  • The patient showed significant improvement following intravenous methylprednisolone treatment.

Findings:

  • The presence of MOG antibodies in serum and CSF confirmed the diagnosis of FLAMES.
  • Elevated MBP levels in the CSF suggest that demyelination is a component of the inflammatory process in this FLAMES case.
  • The findings indicate that both inflammation and demyelination may contribute to the pathophysiology of FLAMES.

Implications:

  • This case highlights the potential for demyelination in FLAMES, expanding our understanding of the disease spectrum.
  • The results suggest that therapeutic strategies targeting both inflammation and demyelination might be beneficial for FLAMES patients.
  • Further research is warranted to elucidate the precise role of demyelination in FLAMES and its impact on patient outcomes.
Keywords:
encephalitismyelin basic proteinmyelin oligodendrocyte glycoprotein antibodymyelitisseizure

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