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Clinical characteristics of MOG antibody-positive anti-NMDAR encephalitis: a single-center retrospective study
Xuan Zou1,2,3,4, Guan-En Zhou1,2,3,4
1Department of Neurology, Tianjin Huanhu Hospital, Tianjin University, Tianjin, China.
Objective:
This study was designed to clarify the clinical characteristics of myelin oligodendrocyte glycoprotein (MOG) antibody-positive anti-N-methyl-D-aspartate receptor (anti-NMDAR) encephalitis.
Methods:
This was a single-center retrospective study. Patients with anti-NMDAR encephalitis hospitalized at Tianjin Huanhu Hospital were included in the study. The observation group consisted of patients with anti-NMDAR encephalitis who tested positive for serum MOG-antibodies [MOG-Ab (+)], while the reference group included patients who tested negative for serum MOG-antibodies [MOG-Ab (-)]. Clinical data were collected from both groups and statistical methods were employed to analyze the differences between the two groups.
Results:
This study enrolled 48 patients (n = 48) with anti-NMDAR encephalitis, comprising eight cases (n = 8, 16.67%) in the MOG-Ab (+) group and 40 cases (n = 40, 83.33%) in the MOG-Ab (-) group. The proportion of male patients in the MOG-Ab (+) group was significantly higher than that in the MOG-Ab (-) group (87.50 vs. 40.00%, χ2 = 4.274, P = 0.039). Patients in the MOG-Ab (+) group frequently experienced headaches, which occurred more often than in the MOG-Ab (-) group (75.00 vs. 25.00%, χ2 = 5.419, P = 0.020). The median white blood cell (WBC) count in the cerebrospinal fluid (CSF) of the MOG-Ab (+) group was 125.00 (65.00, 155.00) × 106/L, representing a rate that is 12.5 times higher than that of the MOG-Ab (-) group, indicating more pronounced immune inflammatory response in the CSF of the MOG-Ab (+) group (Z = -3.320, P = 0.000). Additionally, the MOG-Ab (+) group exhibited a higher proportion of leptomeningeal enhancement (37.50 vs. 2.50%, P = 0.012) and cortical lesions (87.50 vs. 40.00%, χ2 = 4.274, P = 0.039) on MRI. Recurrence occurred in 50.0% of patients in the MOG-Ab (+) group within 1 year of discharge follow-up, compared to only 12.50% in the MOG-Ab (-) group (χ2 = 3.938, P = 0.047).
Conclusion:
For patients with anti-NMDAR encephalitis presenting with headaches, if there is a significant increase in CSF-WBC count, coupled with abnormal MRI signals in the leptomeninges or cortex, it is recommended to test for MOG antibodies. This is particularly crucial for male patients. For those with positive double antibodies, more aggressive long-term immunosuppressive therapy may be necessary to prevent recurrence.
Insights
Myelin oligodendrocyte glycoprotein (MOG) antibody-positive anti-N-methyl-D-aspartate receptor (anti-NMDAR) encephalitis presents differently, with higher rates of male patients, headaches, and MRI abnormalities. These patients also face a significantly higher risk of recurrence, suggesting a need for tailored treatment strategies.
Area of Science:
- Neuroimmunology
- Neurology
- Autoimmune Encephalitis
Background:
- Anti-N-methyl-D-aspartate receptor (anti-NMDAR) encephalitis is a severe autoimmune neurological disorder.
- Co-occurrence with myelin oligodendrocyte glycoprotein (MOG) antibodies is rare but may influence clinical presentation and prognosis.
- Understanding these differences is crucial for accurate diagnosis and effective management.
Purpose of the Study:
- To elucidate the distinct clinical characteristics of anti-NMDAR encephalitis in patients who are also positive for MOG antibodies (MOG-Ab (+)).
- To compare the clinical profiles and outcomes of MOG-Ab (+) anti-NMDAR encephalitis patients with those who are MOG-Ab negative (MOG-Ab (-)).
Main Methods:
- A single-center retrospective study involving 48 patients diagnosed with anti-NMDAR encephalitis.
- Patients were divided into two groups: MOG-Ab (+) (n=8) and MOG-Ab (-) (n=40).
- Clinical data, including demographics, symptoms, cerebrospinal fluid (CSF) analysis, MRI findings, and recurrence rates, were collected and statistically analyzed.
Main Results:
- The MOG-Ab (+) group showed a significantly higher proportion of males (87.5% vs. 40%) and frequent headaches (75% vs. 25%).
- Elevated CSF white blood cell (WBC) counts (12.5 times higher), increased leptomeningeal enhancement (37.5%), and cortical lesions (87.5%) on MRI were more common in the MOG-Ab (+) group.
- Recurrence rates within one year were substantially higher in the MOG-Ab (+) group (50% vs. 12.5%).
Conclusions:
- Testing for MOG antibodies is recommended for anti-NMDAR encephalitis patients with headaches, elevated CSF-WBC, and abnormal MRI findings, especially in male patients.
- The presence of both MOG and NMDAR antibodies indicates a more severe inflammatory response and a higher risk of recurrence.
- Aggressive, long-term immunosuppressive therapy may be warranted for patients with dual antibody positivity to prevent disease relapse.
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