Clinical feature of anti-myelin oligodendrocyte glycoprotein antibody-associated cerebral cortical encephalitis with cerebrospinal fluid anti-N-methyl-D-aspartate receptor antibody co-positivity: a single center case series.

Abstract

Anti-myelin oligodendrocyte glycoprotein antibody-associated cerebral cortical encephalitis (MOG-CCE) occasionally exhibits cerebrospinal fluid (CSF) anti-N-methyl-D-aspartate receptor (NMDAR) antibody co-positivity; however, its clinical relevance remains unclear. This study examined the clinical characteristics of NMDAR antibody-positive and NMDAR antibody-negative MOG-CCE to clarify its clinical implications. Consecutive patients with MOG-CCE admitted to our hospital between January 2015 and July 2025 were included. Clinical, laboratory, and imaging findings, as well as treatments and outcomes, were descriptively analyzed according to the CSF anti-NMDAR antibody status. Ten cases with MOG-CCE were included, with five being NMDAR antibody-positive MOG-CCE. Compared to patients with NMDAR antibody-negative MOG-CCE, patients with NMDAR antibody-positive MOG-CCE appeared to have a higher frequency of psychiatric symptoms (80% vs. 20%), abnormal behavior (80% vs. 0%), and movement disorder (60% vs. 0%). Beyond fluid attenuated inversion recovery hyperintensity and gadolinium enhancement, cerebral perfusion imaging demonstrated regional hyperperfusion in most cases, irrespective of CSF anti-NMDAR antibody status. Functional outcomes were similar (median modified Rankin Scale at final follow-up 0 vs. 0). This study suggests that cases with NMDAR antibody-positive MOG-CCE may represent a synergistic overlap between MOG-CCE and NMDARE, characterized by NMDARE-like symptoms. Cerebral perfusion evaluation may serve as a supportive tool for the assessment of MOG-CCE.