Abstract
Objective
To report clinical presentations and outcomes of patients with seizure and myelin oligodendrocyte glycoprotein antibody associated disease (MOGAD).
Methods
We retrospectively reviewed the electronic medical records for clinical and paraclinical features among patients with seizures and MOG-IgG seropositivity.
Results
We identified 213 patients with MOG-IgG seropositivity who fulfilled criteria for MOGAD. Seizures attributed to CNS autoimmunity were observed in 10% of patients (n=23, 19 children, 4 adults). The majority (n=19, 83%) had pediatric disease onset. Focal motor seizures were the most common seizure semiology (16/23; 70%). Focal to bilateral tonic clonic seizures were present in 12 patients (53%) and 3 patients (13%) developed status epilepticus. All patients had features of encephalitis at onset of seizures. Cerebral cortical encephalitis (CCE) was the most common radiological finding (10 unilateral and 5 bilateral cases). 8/23 patients (35%) had only CCE, 6/23 patients (26%) had only acute disseminated encephalomyelitis and 7/23 patients (30%) had features of both. Fifteen patients (65%) had leptomeningeal enhancement. Three patients (13%) had coexistence of NMDA-R IgG. Only 3/23 patients (13%) developed drug resistant epilepsy. Even though the majority, 14/23 (60%) had MOGAD relapses, only 5/23 patients had recurrence of episodes of encephalitis with associated seizures. 21/23 (91%) had seizure freedom at last follow up.
Significance
MOG-IgG evaluation should be considered among patients presenting with encephalitis and focal motor and/or focal to bilateral tonic clonic seizures, especially among patients in the pediatric age group with MRI brain findings consistent with CCE, ADEM or other MOGAD presentations. The majority of these seizures are self-limited and do not require maintenance/chronic anti-seizure medications. Although seizure recurrence is uncommon, many patients have MOGAD relapses in the form of encephalitis and optic neuritis.
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