Gandarilla-Martínez NA, Rivas-Alonso V, Pérez-Ruiz AA, Flores-Rivera JJ

Language: Spanish
References: 20
Page: 215-220
PDF size: 490.86 Kb.

ABSTRACT

Introduction: Inflammatory idiopathic central nervous system disorders usually present relapsing-remitting clinical courses that reflect the underlying immune-mediated mechanisms. Besides Multiple Sclerosis other demyelinating phenotypes with predilection for optic nerves and spinal cord have been described such as neuromyelitis optica and neuromyelitis optica spectrum disorders, which represent limited or inaugural forms of the former phenotype and the spectrum of anti-myelin oligodendrocyte glycoprotein antibody associated diseases. Despite sharing a similar clinical picture, each disease has its own biomarkers and different pathophysiological mechanisms. Case presentation: A 24-year-old women presented with encephalopathy, left hemiparesis, and meningeal signs. Magnetic resonance imaging showed a widespread involvement of the white matter associated with periventricular and brainstem hyperintensities. After exclusion of reasonable causes, criteria for possible autoimmune encephalitis were met. She was treated with intravenous methylprednisolone followed by tapered oral prednisone with almost complete recovery after three months. Rituximab was started as maintenance therapy, but at the fourth month she developed recurrent optic neuritis. Since this last relapse she hadn’t longer experienced another event for twenty-one months. Recurrent demyelinating episodes suggest an underlying immunological process. Due to the limitations related to the techniques and the availability for determination of antibodies, in this case no antibody was detected.

REFERENCES

1. Akaishi T, Sato DK, Takahashi T, Nakashima I. Clinical spectrum of inflammatory central nervous system demyelinating disorders associated with antibodies against myelin oligodendrocyte glycoprotein. Neurochem Int. 2018; pii: S0197-0186(18)30404-2.; https://doi.org/10.1016/j.neuint.2018.10.016.

2. Dos Passos GR, Oliveira LM, da Costa BK, Apostolos-Pereira SL, Callegaro D, Fujihara K et al. MOG-IgG-associated optic neuritis, encephalitis, and myelitis: Lessons learned from neuromyelitis optica spectrum disorder. Front Neurol. 2018; 9: 1-10.

3. Nagashima M, Osaka H, Ikeda T, Matsumoto A, Miyauchi A, Kaneko K et al. Rituximab was effective for acute disseminated encephalomyelitis followed by recurrent optic neuritis with anti-myelin oligodendrocyte glycoprotein antibodies. Brain Dev. 2018; 40 (7): 607-611.

4. Huppke P, Rostasy K, Karenfort M, Huppke B, Seidl R, Leiz S et al. Acute disseminated encephalomyelitis followed by recurrent or monophasic optic neuritis in pediatric patients. Mult Scler J. 2013; 19 (7): 941-946.

5. Pohl D, Alper G, Van Haren K, Kornberg AJ, Lucchinetti CF, Tenembaum S et al. Acute disseminated encephalomyelitis: Updates on an inflammatory CNS syndrome. Neurology. 2016; 87 (9): S38-45.

6. De Seze J. Myelin oligodendrocyte glycoprotein antibodies in neuromyelitis optica spectrum disorder. Curr Opin Neurol. 2019; 32 (1): 111-114.

7. Van Pelt ED, Wong YY, Ketelslegers IA, Hamann D, Hintzen RQ. Neuromyelitis optica spectrum disorders: comparison of clinical and magnetic resonance imaging characteristics of AQP4-IgG versus MOG-IgG seropositive cases in the Netherlands. Eur J Neurol. 2016; 23 (3): 580-587.

8. Salama S, Pardo S, Levy M. Clinical characteristics of myelin oligodendrocyte glycoprotein antibody neuromyelitis optica spectrum disorder. Mult Scler Relat Disord. 2019; 30: 231-235.

9. Graus F, Titulaer MJ, Balu R, Benseler S, Bien CG, Cellucci T et al. A clinical approach to diagnosis of autoimmune encephalitis. Lancet Neurol. 2016; 15 (4): 391-404.

10. Pirko I. Neuroimaging of demyelinating diseases. Contin Lifelong Learn Neurol. 2008; 14 (4): 118-143.

11. Scolding N. Acute disseminated encephalomyelitis and other inflammatory demyelinating variants. In: Goodin DS. Multiple sclerosis and related disorders. Handbook of Clinical Neurology. Vol. 122 (3rd series). Edinburgh: Elsevier; 2014. pp. 601-611.

12. Kim HJ, Paul F, Lana-Peixoto MA, Tenembaum S, Asgari N, Palace J et al. MRI characteristics of neuromyelitis optica spectrum disorder an international update. Neurology. 2015; 84 (11): 1165-1173.

13. Salama S, Khan M, Levy M, Izbudak I. Radiological characteristics of myelin oligodendrocyte glycoprotein antibody disease. Mult Scler Relat Disord. 2019; 29: 15-22.

14. Wingerchuk DM, Banwell B, Bennett JL, Cabre P, Carroll W, Chitnis T et al. VIEWS & REVIEWS International consensus diagnostic criteria for neuromyelitis optica spectrum disorders. Neurology. 2015; 85: 177-189.

15. Chessa E, Cauli A, Piga M, Mathieu A, Floris A. Demyelinating syndrome in SLE: review of different disease subtypes and report of a case series. Reumatismo. 2017; 69 (4): 175-183.

16. Piga M, Chessa E, Peltz MT, Floris A, Mathieu A, Cauli A. Demyelinating syndrome in SLE encompasses different subtypes: Do we need new classification criteria? Pooled results from systematic literature review and monocentric cohort analysis. Autoimmun Rev. 2017; 16 (3): 244-252.

17. Mariotto S, Monaco S, Peschl P, Coledan I, Mazzi R, Höftberger R et al. MOG antibody seropositivity in a patient with encephalitis: beyond the classical syndrome. BMC Neurol. 2017; 17 (1): 190.

18. Hamid SH, Whittam D, Saviour M, Alorainy A, Mutch K, Linaker S et al. Seizures and encephalitis in myelin oligodendrocyte glycoprotein IgG disease vs aquaporin 4 IgG disease. JAMA Neurol. 2018; 75 (1): 65-71.

19. Fujimori J, Takai Y, Nakashima I, Sato DK, Takahashi T, Kaneko K et al. Bilateral frontal cortex encephalitis and paraparesis in a patient with anti-MOG antibodies. J Neurol Neurosurg Psychiatry. 2017; 88 (6): 534-536.

20. Jarius S, Paul F, Aktas O, Asgari N, Dale RC, de Seze J et al. MOG encephalomyelitis: international recommendations on diagnosis and antibody testing. J Neuroinflammation. 2018; 15 (1): 134-143.