Objective: To analyze the clinical features in children with anti-NMDAR encephalitis combined with myelin oligodendrocyte glycoprotein antibody (MOG ab).
Methods: Clinical data of 7 children with anti-NMDAR encephalitis combined with MOG ab were collected in Guangzhou Women and Children’s Medical Center from January, 2016 to June, 2019.
Results: Average onset age was 6.0±1.3 year-old, male to female was 2:5. Prominent symptoms in anti-NMDAR encephalitis were abnormal mental behavior (7/7), sleep disorder (6/7) and speech disorder (6/7), while in MOG ab related encephalomyelitis were encephalopathy (5/7) and paralysis (4/7). 1 case developed anti-NMDAR encephalitis 1 year after recovery from MOG ab related acute disseminated encephalomyelitis (ADEM). 4 cases developed anti-NMDAR encephalitis and MOG ab related ADEM simultaneously, with 2 cases relapsed. 2 cases were anti-NMDAR encephalitis with only MOG ab positive. 10 MRI examinations were performed in acute stage. 8/10 brain MRI showed abnormalities with multiple demyelinating lesions mainly involve subcortical white matter (7/8), cortex (6/8) and basal ganglia (5/8). 2/10 had long segment myelitis. Patients improved significantly after corticosteroid and intravenous immunoglobulin (IVIG) treatment. Patients with recurrent course (n=2) had higher MOG ab titer (1:320) and longer duration (≥12 months) compared with non-recurrent course (n=5), MOG antibody(≤1:100) (≤6 months). 3 Cases had neurological sequelae with higher cerebrospinal fluid (CSF) NMDAR antibody titer at first onset (1:320). 2 had emotional problems and 1 had epilepsy.
Conclusion: Children with anti-NMDAR encephalitis combined with MOG ab were more common in girls around 6 year-old. Patients responded well to Corticosteroid and IVIG. Cases with persistent MOG ab need longer follow-up due to recurrent risk, high titer of CSF NMDAR antibody may cause neurological sequelae. Keywords: anti-NMDAR encephalitis, myelin oligodendrocyte glycoprotein antibody, children