New-onset epilepsy in a patient with myelin oligodendrocyte glycoprotein antibodies

Abstract

In the literature, several adult cases with myelin oligodendrocyte glycoprotein (MOG) antibodies (Abs)-associated disorders have been reported to have seizure and acute disseminated encephalomyelitis (ADEM) as the main clinical manifestations, but the number is somewhat low. Because of its rarity, the clinical characteristics and a consensus on treatment have not yet been established in the adult form of ADEM and seizure phenotypes in MOG-Abs-associated disorders. In this report, we described an adult patient who presented with status epilepticus as the index event, had been suffering from chronic epilepsy, and had positive antibodies for MOG. Neither increasing the doses of the antiseizure drugs (ASDs) nor adding another new ASD reduced the prevalence of the seizures. However, he became seizure-free after the addition of azathioprine and incremental increases of methylprednisolone dosage. This case clearly indicates the effectiveness of corticosteroid and azathioprine, as well as the futility of ASDs in the management of seizure control by showing the temporal trajectory relationship among ASDs, steroids, azathioprine and seizure frequency.

Keywords: Epilepsy; Immunosuppressive agents; Myelin-oligodendrocyte glycoprotein.