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.

中文翻译：

---

抗N-甲基-D-天冬氨酸受体脑炎和髓鞘少突胶质细胞糖蛋白抗体相关脑脊髓炎的临床特征和治疗：1例报告并文献复习

背景

抗 N-甲基-D-天冬氨酸 (NMDA) 受体脑炎是由靶向 NMDA 受体 GluN1 亚基的抗体引起的自身免疫性脑炎。髓鞘少突胶质细胞糖蛋白 (MOG) 抗体疾病现在被广泛认为是具有特定临床和病理特征的特殊神经免疫疾病。已经报道了一些罕见的抗 NMDA 受体脑炎和 MOG 抗体相关疾病重叠的病例，呈现出复杂的临床症状，使该疾病更难以识别。

方法

根据系统评价和荟萃分析的首选报告项目 (PRISMA) 指南，在 PubMed 中搜索了术语“NMDAR”和“MOG”、“NMDAR”和“脱髓鞘”以及“MOG”和“脑炎”。本研究纳入病程中抗 NMDA 脑脊液受体和 MOG 血清抗体双阳性的临床病例。

结果

本研究共分析了 25 名患者。发病年龄为 3 至 54 岁。复发的中位数为 2.8。静脉注射甲基强的松龙和免疫球蛋白是最广泛使用的治疗策略（19/25 患者）。还报道了二线治疗，例如给予霉酚酸酯、利妥昔单抗、干扰素-β、硫唑嘌呤、环磷酰胺和替莫唑胺，随后取得了良好的结果。

结论

抗 NMDA 受体脑炎和 MOG 抗体相关脑脊髓炎并存的发生率可能被低估了。伴有非典型中枢神经系统脱髓鞘的癫痫发作和认知能力下降等临床症状可作为抗 NMDA 受体脑炎和 MOG 抗体相关脑脊髓炎可能并存的警告信号。这些患者在适当的免疫疗法下可以获得良好的结果。