Department of Neurology, Nagoya Ekisaikai Hospital, Nagoya, Japan.
Department of Neurology, Masuko Memorial Hospital, Nagoya, Japan.
Front Immunol. 2024 Jun 4;15:1392992. doi: 10.3389/fimmu.2024.1392992. eCollection 2024.
Recently, cases of overlapping encephalitis caused by anti-N-methyl-D-aspartate receptor (anti-NMDAR) and anti-myelin oligodendrocyte glycoprotein (MOG) antibodies have been reported, and their clinical characteristics are gradually becoming clear. Acute-phase treatment typically involves the use of steroids, and although some studies have suggested that steroids can be effective, the extent of their efficacy has not yet been fully explored.
We present the case of a 25-year-old man with anti-NMDAR and anti-MOG antibody overlapping encephalitis who showed considerable improvement after steroid treatment. To gain a deeper understanding of the efficacy of steroids in managing this condition, we conducted a literature review of cases of anti-NMDAR and anti-MOG antibody double-positive encephalitis that were treated with steroids during the acute phase. Thirteen cases were analyzed, including a new case diagnosed at our hospital. All patients showed improvement after receiving steroid treatment in the acute phase. Ten patients did not have any sequelae, and nine of them showed a rapid or major response during the acute phase. In contrast, three patients experienced sequelae (mild cognitive decline, visual impairment, and memory impairment, respectively), with their response to steroids in the acute phase being slow or limited. Relapses occurred in five patients, in one patient during steroid tapering, and in another two patients after cessation of steroids.
Steroid therapy can be effective in the acute stage of anti-NMDAR and anti-MOG antibody overlapping encephalitis. A positive prognosis may be expected in patients who experience substantial improvement with steroid therapy during the acute phase.
最近，报道了一些抗 N-甲基-D-天冬氨酸受体（抗 NMDAR）和抗髓鞘少突胶质细胞糖蛋白（抗 MOG）抗体重叠脑炎的病例，其临床特征逐渐清晰。急性期的治疗通常包括使用类固醇，尽管一些研究表明类固醇可能有效，但它们的疗效程度尚未得到充分探索。
我们报告了一例 25 岁男性抗 NMDAR 和抗 MOG 抗体重叠脑炎患者，在类固醇治疗后有明显改善。为了更深入地了解类固醇在治疗这种疾病中的疗效，我们对急性期接受类固醇治疗的抗 NMDAR 和抗 MOG 抗体双阳性脑炎病例进行了文献回顾。分析了 13 例病例，包括我院新诊断的一例病例。所有患者在急性期接受类固醇治疗后均有改善。10 例患者无后遗症，其中 9 例在急性期有快速或主要反应。相比之下，3 例患者出现后遗症（分别为轻度认知衰退、视力障碍和记忆力障碍），他们在急性期对类固醇的反应较慢或有限。5 例患者复发，1 例在类固醇减量期间，2 例在停用类固醇后。
类固醇治疗在抗 NMDAR 和抗 MOG 抗体重叠脑炎的急性期可能有效。在急性期接受类固醇治疗有明显改善的患者，预后可能较好。
