nach oben

Neurological Sciences

Erschienen in:

07.01.2021 | Review Article

Clinical features and management of coexisting anti-N-methyl-D-aspartate receptor encephalitis and myelin oligodendrocyte glycoprotein antibody–associated encephalomyelitis: a case report and review of the literature

verfasst von: Di Nan, Ying Zhang, Jinming Han, Tao Jin

Erschienen in: Neurological Sciences | Ausgabe 3/2021

Einloggen, um Zugang zu erhalten

Abstract

Background

Anti-N-methyl-D-aspartate (NMDA) receptor encephalitis is an autoimmune encephalitis caused by antibodies targeting the GluN1 subunit of NMDA receptors. Myelin oligodendrocyte glycoprotein (MOG) antibody disorders are now widely accepted as peculiar neuroimmunological diseases with specific clinical and pathological features. Some rare cases of overlapping anti-NMDA receptor encephalitis and MOG antibody–associated diseases have been reported, presenting complex clinical symptoms that make the disease more difficult to recognize.

Method

In accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines, the terms “NMDAR” and “MOG,” “NMDAR” and “demyelination,” and “MOG” and “encephalitis” were searched in PubMed. Clinical cases with dual-positive anti-NMDA cerebrospinal fluid receptors and MOG serum antibodies during the disease course were included in this study.

Results

A total of 25 patients were analyzed in this study. The age at onset ranged from 3 to 54 years. The median number of relapses was 2.8. Administration of intravenous methylprednisolone and immunoglobulin was the most widely used treatment strategy (19/25 patients). Second-line treatments such as administration of mycophenolate mofetil, rituximab, interferon-β, azathioprine, cyclophosphamide, and temozolomide were also reported, followed by good outcomes.

Conclusions

The rates of coexisting anti-NMDA receptor encephalitis and MOG antibody–associated encephalomyelitis may be underestimated. Clinical symptoms such as seizures and cognitive decline accompanied by atypical central nervous system demyelination serve as warning signs of possible coexisting anti-NMDA receptor encephalitis and MOG antibody–associated encephalomyelitis. These patients could achieve good outcomes under proper immunotherapies.

Nur mit Berechtigung zugänglich

Brunner C, Lassmann H, Waehneldt TV, Matthieu JM, Linington C (1989) Differential ultrastructural localization of myelin basic protein, myelin/oligodendroglial glycoprotein, and 2′,3′-cyclic nucleotide 3′-phosphodiesterase in the CNS of adult rats. J Neurochem 52:296–304. https://doi.org/10.1111/j.1471-4159.1989.tb10930.xCrossRefPubMed

Johns TG, Bernard CC (1999) The structure and function of myelin oligodendrocyte glycoprotein. J Neurochem 72:1–9. https://doi.org/10.1046/j.1471-4159.1999.0720001.xCrossRefPubMed

Pittock SJ, Reindl M, Achenbach S, Berger T, Bruck W, Konig F, Morales Y, Lassmann H, Bryant S, Moore SB, Keegan BM, Lucchinetti CF (2007) Myelin oligodendrocyte glycoprotein antibodies in pathologically proven multiple sclerosis: frequency, stability and clinicopathologic correlations. Mult Scler 13:7–16. https://doi.org/10.1177/1352458506072189CrossRefPubMed

Pröbstel AK, Dornmair K, Bittner R, Sperl P, Jenne D, Magalhaes S, Villalobos A, Breithaupt C, Weissert R, Jacob U, Krumbholz M, Kuempfel T, Blaschek A, Stark W, Gärtner J, Pohl D, Rostasy K, Weber F, Forne I, Khademi M, Olsson T, Brilot F, Tantsis E, Dale RC, Wekerle H, Hohlfeld R, Banwell B, Bar-Or A, Meinl E, Derfuss T (2011) Antibodies to MOG are transient in childhood acute disseminated encephalomyelitis. Neurology 77:580–588. https://doi.org/10.1212/WNL.0b013e318228c0b1CrossRefPubMed

Wynford-Thomas R, Jacob A, Tomassini V (2019) Neurological update: MOG antibody disease. J Neurol 266:1280–1286. https://doi.org/10.1007/s00415-018-9122-2CrossRefPubMed

Jarius S, Paul F, Aktas O, Asgari N, Dale RC, de Seze J, Franciotta D, Fujihara K, Jacob A, Kim HJ, Kleiter I, Kümpfel T, Levy M, Palace J, Ruprecht K, Saiz A, Trebst C, Weinshenker BG, Wildemann B (2018) MOG encephalomyelitis: international recommendations on diagnosis and antibody testing. J Neuroinflammation 15:134. https://doi.org/10.1186/s12974-018-1144-2CrossRefPubMedPubMedCentral

Waters P, Fadda G, Woodhall M, O'Mahony J, Brown RA, Castro DA, Longoni G, Irani SR, Sun B, Yeh EA, Marrie RA, Arnold DL, Banwell B, Bar-Or A (2020) Serial anti-myelin oligodendrocyte glycoprotein antibody analyses and outcomes in children with demyelinating syndromes. JAMA Neurol 77:82–93. https://doi.org/10.1001/jamaneurol.2019.2940CrossRefPubMed

Takai Y, Misu T, Kaneko K, Chihara N, Narikawa K, Tsuchida S, Nishida H, Komori T, Seki M, Komatsu T, Nakamagoe K, Ikeda T, Yoshida M, Takahashi T, Ono H, Nishiyama S, Kuroda H, Nakashima I, Suzuki H, Bradl M, Lassmann H, Fujihara K, Aoki M, Otsuka Y, Nishimaki K, Ishigaki S, Yoshida K, Iguchi Y, Fukuda T, Nohara S, Tamaoka A, Fujimori J (2020) Myelin oligodendrocyte glycoprotein antibody-associated disease: an immunopathological study. Brain 143:1431–1446. https://doi.org/10.1093/brain/awaa102CrossRefPubMed

Dalmau J, Lancaster E, Martinez-Hernandez E, Rosenfeld MR, Balice-Gordon R (2011) Clinical experience and laboratory investigations in patients with anti-NMDAR encephalitis. Lancet Neurol 10:63–74. https://doi.org/10.1016/S1474-4422(10)70253-2CrossRefPubMedPubMedCentral

10.

Graus F, Titulaer MJ, Balu R, Benseler S, Bien CG, Cellucci T, Cortese I, Dale RC, Gelfand JM, Geschwind M, Glaser CA, Honnorat J, Höftberger R, Iizuka T, Irani SR, Lancaster E, Leypoldt F, Prüss H, Rae-Grant A, Reindl M, Rosenfeld MR, Rostásy K, Saiz A, Venkatesan A, Vincent A, Wandinger KP, Waters P, Dalmau J (2016) A clinical approach to diagnosis of autoimmune encephalitis. Lancet Neurol 15:391–404. https://doi.org/10.1016/S1474-4422(15)00401-9CrossRefPubMedPubMedCentral

11.

Dalmau J, Gleichman AJ, Hughes EG, Rossi JE, Peng X, Lai M, Dessain SK, Rosenfeld MR, Balice-Gordon R, Lynch DR (2008) Anti-NMDA-receptor encephalitis: case series and analysis of the effects of antibodies. Lancet Neurol 7:1091–1098. https://doi.org/10.1016/S1474-4422(08)70224-2CrossRefPubMedPubMedCentral

12.

Titulaer MJ, McCracken L, Gabilondo I, Armangué T, Glaser C, Iizuka T, Honig LS, Benseler SM, Kawachi I, Martinez-Hernandez E, Aguilar E, Gresa-Arribas N, Ryan-Florance N, Torrents A, Saiz A, Rosenfeld MR, Balice-Gordon R, Graus F, Dalmau J (2013) Treatment and prognostic factors for long-term outcome in patients with anti-NMDA receptor encephalitis: an observational cohort study. Lancet Neurol 12:157–165. https://doi.org/10.1016/S1474-4422(12)70310-1CrossRefPubMedPubMedCentral

13.

Martinez-Hernandez E, Guasp M, García-Serra A, Maudes E, Ariño H, Sepulveda M, Armangué T, Ramos AP, Ben-Hur T, Iizuka T, Saiz A, Graus F, Dalmau J (2020) Clinical significance of anti-NMDAR concurrent with glial or neuronal surface antibodies. Neurology 94:e2302–e2310. https://doi.org/10.1212/WNL.0000000000009239CrossRefPubMed

14.

Titulaer MJ, Höftberger R, Iizuka T, Leypoldt F, McCracken L, Cellucci T, Benson LA, Shu H, Irioka T, Hirano M, Singh G, Cobo Calvo A, Kaida K, Morales PS, Wirtz PW, Yamamoto T, Reindl M, Rosenfeld MR, Graus F, Saiz A, Dalmau J (2014) Overlapping demyelinating syndromes and anti-N-methyl-D-aspartate receptor encephalitis. Ann Neurol 75:411–428. https://doi.org/10.1002/ana.24117CrossRefPubMedPubMedCentral

15.

Hou C, Wu W, Tian Y, Zhang Y, Zhu H, Zeng Y, Peng B, Zheng K, Li X, Chen W (2020) Clinical analysis of anti-NMDAR encephalitis combined with MOG antibody in children. Mult Scler Relat Disord 42:102018. https://doi.org/10.1016/j.msard.2020.102018CrossRefPubMed

16.

Zhang J, Ji T, Chen Q, Jiang Y, Cheng H, Zheng P, Ma W, Lei T, Zhang Y, Jin Y, Wei C, Wu Y, Chang X, Bao X, Zhang Y, Xiong H, Ji X, Feng S, Ren H, Yang J, Jiang Y (2019) Pediatric autoimmune encephalitis: case series from two Chinese tertiary pediatric neurology centers. Front Neurol 10:906. https://doi.org/10.3389/fneur.2019.00906CrossRefPubMedPubMedCentral

17.

Wegener-Panzer A, Cleaveland R, Wendel EM, Baumann M, Bertolini A, Häusler M, Knierim E, Reiter-Fink E, Breu M, Sönmez Ö, Della Marina A, Peters R, Lechner C, Piepkorn M, Roll C, Höftberger R, Leypoldt F, Reindl M, Rostásy K (2020) Clinical and imaging features of children with autoimmune encephalitis and MOG antibodies. Neurol Neuroimmunol Neuroinflamm 7:e731. https://doi.org/10.1212/NXI.0000000000000731CrossRefPubMedPubMedCentral

18.

Aoe S, Kokudo Y, Takata T, Kobara H, Yamamoto M, Touge T, Deguchi K, Masaki T (2019) Repeated anti-N-methyl-D-aspartate receptor encephalitis coexisting with anti-myelin oligodendrocyte glycoprotein antibody-associated diseases: a case report. Mult Scler Relat Disord 35:182–184. https://doi.org/10.1016/j.msard.2019.08.002CrossRefPubMed

19.

Taraschenko O, Zabad R (2019) Overlapping demyelinating syndrome and anti-methyl-d-aspartate receptor encephalitis with seizures. Epilepsy Behav Rep 12:100338. https://doi.org/10.1016/j.ebr.2019.100338CrossRefPubMedPubMedCentral

20.

Yokoyama K, Hori M, Yoshida A (2016) Anti-myelin oligodendrocyte glycoprotein antibody neuritis optica following anti-NMDA receptor encephalitis. Pediatr Int 58:953–954. https://doi.org/10.1111/ped.13053CrossRefPubMed

21.

Zhou L, ZhangBao J, Li H, Li X, Huang Y, Wang M, Zhao C, Lu J, Lu C, Li Y, Quan C (2017) Cerebral cortical encephalitis followed by recurrent CNS demyelination in a patient with concomitant anti-MOG and anti-NMDA receptor antibodies. Mult Scler Relat Disord 18:90–92. https://doi.org/10.1016/j.msard.2017.09.023CrossRefPubMed

22.

Zhou J, Tan W, Tan SE, Hu J, Chen Z, Wang K (2018) An unusual case of anti-MOG CNS demyelination with concomitant mild anti-NMDAR encephalitis. J Neuroimmunol 320:107–110. https://doi.org/10.1016/j.jneuroim.2018.03.019CrossRefPubMed

23.

Fan S, Xu Y, Ren H, Guan H, Feng F, Gao X, Ding D, Fang F, Shan G, Guan T, Zhang Y, Dai Y, Yao M, Peng B, Zhu Y, Cui L (2018) Comparison of myelin oligodendrocyte glycoprotein (MOG)-antibody disease and AQP4-IgG-positive neuromyelitis optica spectrum disorder (NMOSD) when they co-exist with anti-NMDA (N-methyl-D-aspartate) receptor encephalitis. Mult Scler Relat Disord 20:144–152. https://doi.org/10.1016/j.msard.2018.01.007CrossRefPubMed

24.

Rojc B, Podnar B, Graus F (2019) A case of recurrent MOG antibody positive bilateral optic neuritis and anti-NMDAR encephalitis: different biological evolution of the two associated antibodies. J Neuroimmunol 328:86–88. https://doi.org/10.1016/j.jneuroim.2018.12.003CrossRefPubMed

25.

Sarigecili E, Cobanogullari M, Komur M, Okuyaz C (2019) A rare concurrence: antibodies against myelin oligodendrocyte glycoprotein and N-methyl-d-aspartate receptor in a child. Mult Scler Relat Disord 28:101–103. https://doi.org/10.1016/j.msard.2018.12.017CrossRefPubMed

26.

Pérez CA, Agyei P, Gogia B, Harrison R, Samudralwar R (2020) Overlapping autoimmune syndrome: a case of concomitant anti-NMDAR encephalitis and myelin oligodendrocyte glycoprotein (MOG) antibody disease. J Neuroimmunol 339:577124. https://doi.org/10.1016/j.jneuroim.2019.577124CrossRefPubMed

27.

Ma J, Jiang L (2020) Viral encephalitis followed by anti-NMDAR encephalitis with concomitant MOG antibody-positive central nervous system demyelination in a child. Neurosci 41:2303–2305. https://doi.org/10.1007/s10072-020-04357-xCrossRef

28.

Wang L, ZhangBao J, Zhou L, Zhang Y, Li H, Li Y, Huang Y, Wang M, Lu C, Lu J, Zhao C, Quan C (2019) Encephalitis is an important clinical component of myelin oligodendrocyte glycoprotein antibody associated demyelination: a single-center cohort study in Shanghai, China. Eur J Neurol 26:168–174. https://doi.org/10.1111/ene.13790CrossRefPubMed

29.

Kunchok A, Chen JJ, Mckeon A, Mills JR, Flanagan EP, Pittock SJ (2020) Coexistence of myelin oligodendrocyte glycoprotein and Aquaporin-4 antibodies in adult and pediatric patients. JAMA Neurol 77:257–259. https://doi.org/10.1001/jamaneurol.2019.3656CrossRefPubMed

30.

Zhou J, Lu X, Zhang Y, Ji T, Jin Y, Xu M, Bao X, Zhang Y, Xiong H, Chang X, Jiang Y, Wu Y (2019) Follow-up study on Chinese children with relapsing MOG-IgG-associated central nervous system demyelination. Mult Scler Relat Disord 28:4–10. https://doi.org/10.1016/j.msard.2018.12.001CrossRefPubMed

31.

Lipton SA (2006) NMDA receptors, glial cells, and clinical medicine. Neuron 50:9–11. https://doi.org/10.1016/j.neuron.2006.03.026CrossRefPubMed

32.

Mayer MC, Meinl E (2012) Glycoproteins as targets of autoantibodies in CNS inflammation: MOG and more. Ther Adv Neurol Disord 5:147–159. https://doi.org/10.1177/1756285611433772CrossRefPubMedPubMedCentral

33.

Höftberger R, Guo Y, Flanagan EP, Lopez-Chiriboga AS, Endmayr V, Hochmeister S, Joldic D, Pittock SJ, Tillema JM, Gorman M, Lassmann H, Lucchinetti CF (2020) The pathology of central nervous system inflammatory demyelinating disease accompanying myelin oligodendrocyte glycoprotein autoantibody. Acta Neuropathol 139:875–892. https://doi.org/10.1007/s00401-020-02132-yCrossRefPubMedPubMedCentral

34.

Hohlfeld R (2018) B-cells as therapeutic targets in neuro-inflammatory diseases. Clin Immunol 186:51–53. https://doi.org/10.1016/j.clim.2017.07.013CrossRefPubMed

35.

Cobo-Calvo A, Ruiz A, Marignier R (2019) Myelin oligodendrocyte glycoprotein antibody associated disease: about the importance of diagnostic assays and selection of the target population in retrospective studies. Eur J Neurol 26:e58–e59. https://doi.org/10.1111/ene.13896CrossRefPubMed

36.

Ramberger M, Bsteh G, Schanda K, Höftberger R, Rostásy K, Baumann M, Aboulenein-Djamshidian F, Lutterotti A, Deisenhammer F, Berger T, Reindl M (2015) NMDA receptor antibodies: a rare association in inflammatory demyelinating diseases. Neruol Neuroimmunol Neuroinflamm 2:e141. https://doi.org/10.1212/NXI.0000000000000141CrossRef

37.

Ren Y, Chen X, He Q, Wang R, Lu W (2019) Co-occurrence of anti-N-methyl-D-aspartate receptor encephalitis and anti-myelin oligodendrocyte glycoprotein inflammatory demyelinating diseases: a clinical phenomenon to be taken seriously. Front Neurol 10:1271. https://doi.org/10.3389/fneur.2019.01271CrossRefPubMedPubMedCentral

38.

Kaneko K, Sato DK, Misu T, Kurosawa K, Nakashima I, Fujihara K, Aoki M (2014) Anti-N-methyl-D-aspartate receptor encephalitis with multiphasic demyelination. Ann Neurol 76:462–464. https://doi.org/10.1002/ana.24224CrossRefPubMed

39.

Hansen HC, Klingbeil C, Dalmau J, Li W, Weissbrich B, Wandinger KP (2013) Persistent intrathecal antibody synthesis 15 years after recovering from anti-N-methyl-D-aspartate receptor encephalitis. JAMA Neurol 70:117–119. https://doi.org/10.1001/jamaneurol.2013.585CrossRefPubMedPubMedCentral

40.

Mariotto S, Andreetta F, Farinazzo A, Monaco S, Ferrari S (2017) Persistence of anti-NMDAR antibodies in CSF after recovery from autoimmune encephalitis. Neurol Sci 38:1523–1524. https://doi.org/10.1007/s10072-017-2958-xCrossRefPubMed

41.

Oliveira LM, Apóstolos-Pereira SL, Pitombeira MS, Bruel Torretta PH, Callegaro D, Sato DK (2019) Persistent MOG-IgG positivity is a predictor of recurrence in MOG-IgG-associated optic neuritis, encephalitis, and myelitis. Mult Scler 25:1907–1914. https://doi.org/10.1177/1352458518811597CrossRefPubMed

42.

Hyun JW, Woodhall MR, Kim SH, Jeong IH, Kong B, Kim G, Kim Y, Park MS, Irani SR, Waters P, Kim HJ (2017) Longitudinal analysis of myelin oligodendrocyte glycoprotein antibodies in CNS inflammatory diseases. J Neruol Neurosurg Psychiatry 88:811–817. https://doi.org/10.1136/jnnp-2017-315998CrossRef

Titel: Clinical features and management of coexisting anti-N-methyl-D-aspartate receptor encephalitis and myelin oligodendrocyte glycoprotein antibody–associated encephalomyelitis: a case report and review of the literature
verfasst von: Di Nan
Ying Zhang
Jinming Han
Tao Jin
Publikationsdatum: 07.01.2021
Verlag: Springer International Publishing
Erschienen in: Neurological Sciences / Ausgabe 3/2021
Print ISSN: 1590-1874
Elektronische ISSN: 1590-3478
DOI: https://doi.org/10.1007/s10072-020-04942-0

Leitlinien kompakt für die Neurologie

Mit medbee Pocketcards sicher entscheiden.

^{Seit 2022 gehört die medbee GmbH zum Springer Medizin Verlag}

Kostenlos registrieren

Neu im Fachgebiet Neurologie

18.04.2024 | Arterielle Hypertonie | Nachrichten

Update Neurologie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

Newsletter bestellen

Live-Webinar: Aktuelle Leitlinien bei Herz-Kreislauf-Erkrankungen

Springer Medizin

Clinical features and management of coexisting anti-N-methyl-D-aspartate receptor encephalitis and myelin oligodendrocyte glycoprotein antibody–associated encephalomyelitis: a case report and review of the literature

Abstract

Background

Method

Results

Conclusions

Leitlinien kompakt für die Neurologie

Neu im Fachgebiet Neurologie

Antihypertensiva schützen auch alte Menschen noch vor Demenz

Spinale Muskelatrophie: Neugeborenen-Screening lohnt sich

Manche Gestagene können das Risiko für Meningeome erhöhen

Parkinson: Größere Studie bestätigt Genauigkeit von Hauttest

Update Neurologie

Live-Webinar: Aktuelle Leitlinien bei Herz-Kreislauf-Erkrankungen

Springer Medizin

Abstract

Background

Method

Results

Conclusions

Bitte loggen Sie sich ein, um Zugang zu diesem Inhalt zu erhalten

Weitere Artikel der Ausgabe 3/2021

In the borderland of multifocal motor neuropathy and chronic inflammatory demyelinating polyradiculopathy

High plasma levels of trimethylamine N-oxide are associated with poor outcome in intracerebral hemorrhage patients

Neuronal ceroid lipofuscinosis: genetic and phenotypic spectrum of 14 patients from Turkey

Reply to “Axonal” form of Guillain-Barré syndrome in a patient receiving oxaliplatin-based chemotherapy

Retinal nerve fiber layer changes in migraine: a systematic review and meta-analysis

Holmes tremor and palatal tremor in hypertrophic olivary degeneration: involvement of brainstem

Leitlinien kompakt für die Neurologie

Neu im Fachgebiet Neurologie

Antihypertensiva schützen auch alte Menschen noch vor Demenz

Spinale Muskelatrophie: Neugeborenen-Screening lohnt sich

Manche Gestagene können das Risiko für Meningeome erhöhen

Parkinson: Größere Studie bestätigt Genauigkeit von Hauttest

Update Neurologie