Clinical characteristics of patients with anti⁃myelin oligodendrocyte glycoprotein ⁃IgG associated disorders complicated with antibody overlap syndrome

Abstract

Objective To summarize the clinical characteristics of anti⁃myelin oligodendrocyte glycoprotein⁃IgG associated disorders (MOGAD) complicated with antibody overlap syndrome. Methods and Results Ten patients with MOGAD complicated with antibody overlap syndrome treated in the First Affiliated Hospital of Zhengzhou University and the Fifth Affiliated Hospital of Zhengzhou University from April 2016 to April 2021 were included, including 7 patients with N⁃methyl⁃D aspartate receptor (NMDAR)⁃IgG positive, 2 patients with contactin⁃associated protein 2 (CASPR2)⁃IgG positive and one patient with glial fibrillary acidic protein (GFAP)⁃IgG. The ratio of male to female was 1∶2.33, and the average age of onset was 20.70 years old. Five cases had a history of precursor infection. Headache and fever were the most common initial symptoms. The average Expanded Disability Status Scale (EDSS) score at admission was 2.40. Intracranial pressure (ICP) increased in 5 cases, white blood cell count in cerebrospinal fluid (CSF) increased in 8 cases, and there was no tumor. Head MRI abnormalities in 9 cases, involving both supratentorial and infratentorial, were common in subcortical white matter, brainstem, thalamus and cerebellum. Enhancement scan showed patchy and nodular enhancement, with some linear enhancement of meninges. Spine MRI abnormalities were found in 6 cases, especially in cervical and thoracic spinal cord, which showed long segment spinal cord injury. Optic nerve was involved in 2 cases. Partial or complete remission was achieved after immunomodulatory treatment. The EDSS score decreased by 1-3.50 at discharge. The average follow⁃up was 12.80 months. Three cases recurred and responded well after immunomodulatory treatment again. Conclusions MOGAD complicated with antibody overlap syndrome can detect MOG⁃IgG and other types of autoimmune antibodies at the same time or successively, but it can only show the symptoms of one of the diseases. It has a good response to immunomodulatory treatment, and immunomodulatory treatment is still effective after recurrence.

doi：10.3969/j.issn.1672⁃6731.2022.06.013