Analysis of three encephalitis cases with double positive for N-methyl-D-aspartate receptor and myelinating oligodendrocyte glycoprotein antibodies

ZHU Lin; JIANG Li; YU Long; WU Jian; YIN Mengmei; HUANG Junwen; MA Cancan

doi:10.7619/jcmp.20233266

Journal of Clinical Medicine in Practice > 2024 > 28(2): 49-54, 59. > DOI: 10.7619/jcmp.20233266

ZHU Lin, JIANG Li, YU Long, WU Jian, YIN Mengmei, HUANG Junwen, MA Cancan. Analysis of three encephalitis cases with double positive for N-methyl-D-aspartate receptor and myelinating oligodendrocyte glycoprotein antibodies[J]. Journal of Clinical Medicine in Practice, 2024, 28(2): 49-54, 59. DOI: 10.7619/jcmp.20233266

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Analysis of three encephalitis cases with double positive for N-methyl-D-aspartate receptor and myelinating oligodendrocyte glycoprotein antibodies

1.
Department of Neurology, School of Clinical Medicine of Yangzhou University, Subei People's Hospital Affiliated to Yangzhou University, Yangzhou, Jiangsu, 225000
2.
Department of Geriatrics, School of Clinical Medicine of Yangzhou University, Subei People's Hospital Affiliated to Yangzhou University, Yangzhou, Jiangsu, 225000
3.
Department of Imaging, School of Clinical Medicine of Yangzhou University, Subei People's Hospital Affiliated to Yangzhou University, Yangzhou, Jiangsu, 225000

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Received Date: October 14, 2023
Revised Date: December 13, 2023
Available Online: January 25, 2024

Graphical Abstract

Abstract

Abstract

Objective
To observe the clinical manifestations of 3 cases with myelin oligodendrocyte glycoprotein (MOG) antibody-associated disease and anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis antibody overlapping syndrome (MNOS), aiming to expand the understanding of the clinical spectrum of such syndromes.
Methods
Retrospective analysis was performed on the data of 3 patients with MNOS who were positive for both MOG antibodies and NMDAR antibodies. Clinical features, neuroimaging characteristics, and outcomes were collected, and cell-based assay (CBA) technique was used for diagnosis.
Results
One case presented both positive MOG antibodies and NMDAR antibodies, but the clinical manifestations were typical symptoms of anti-NMDAR encephalitis. In one case, the clinical and cranial magnetic resonance imaging (MRI) features of demyelinating disease recurred after anti-NMDAR encephalitis, with atypical symptoms of MNOS such as numbness and weakness in limbs, blurred vision, and diplopia. The last case presented both positive MOG antibodies and NMDAR antibodies, but the clinical manifestations were typical symptoms of anti-NMDAR encephalitis. In MNOS, MOG antibody-associated disease and anti-NMDAR encephalitis may appear simultaneously or sequentially, with epilepsy being the most common symptom. Cranial MRI findings showed that the patients presented and mainly involved supratentorial lesions, which may also involve the brainstem, but no spinal cord lesions were found. All patients showed slightly abnormal cerebrospinal fluid. Patients showed a good response to first-line immunotherapy during the acute phase of the disease, with a favorable prognosis. But most patients were prone to relapse.
Conclusion
In MNOS patients, anti-NMDAR encephalitis may present with clinical and(or)MRI features of demyelinating disease simultaneously or sequentially. The clinical manifestations of patients are complex and diverse. Patients with atypical symptoms require to improving the understanding of MNOS and timely treatment.
- myelin oligodendrocyte glycoprotein,
- anti-N-methyl-D-aspartate receptor,
- encephalitis,
- overlap syndrome

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References

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Analysis of three encephalitis cases with double positive for N-methyl-D-aspartate receptor and myelinating oligodendrocyte glycoprotein antibodies

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