title: Myelin Oligodendrocyte Glycoprotein Antibody Persistency in a Steroid-Dependent ADEM Case.
abstract: Myelin oligodendrocyte glycoprotein (MOG) is a candidate target antigen in demyelinating central nervous system diseases, including acute disseminated encephalomyelitis (ADEM), neuromyelitis optica, and multiple sclerosis. It may give prognostic information regarding monophasic or recurrent course of the disease. MOG antibodies have been shown to be positive in high titers during the first episode of ADEM with rapidly decreasing to undetectable limits after recovery. However, persistent MOG antibodies are considered as a predicting factor for multiple sclerosis, optic neuritis relapses, and incomplete recovery of ADEM. Here we report a unique case with persistent MOG antibodies presented with multiphasic ADEM-like attacks. A 6-year-old girl was consulted with encephalopathy, gait disturbance, and oculomotor nerve palsy. Periventricular white matter lesions were seen on cranial magnetic resonance imaging studies. ADEM was diagnosed and treated with steroid. During follow-up, she experienced repeated episodes after steroid therapy termination. We were able to search MOG antibody at the ninth attack. The positivity of this antibody remained. It was thought to be associated with steroid-dependent course, and azathioprine and intravenous human immunoglobulin treatment were added. Patients with persistent MOG antibodies may benefit from addition of immunosuppressant agents, which may decrease the number of attacks.
authors.affiliation: Departments of Pediatric Neurology, and ipekkalafatcilar@gmail.com.
authors.forename: İpek
authors.initials: İ
authors.lastname: Polat
authors.affiliation: Departments of Pediatric Neurology, and.
authors.forename: Uluç
authors.initials: U
authors.lastname: Yiş
authors.affiliation: Departments of Pediatric Neurology, and.
authors.forename: Pakize
authors.initials: P
authors.lastname: Karaoğlu
authors.affiliation: Departments of Pediatric Neurology, and.
authors.forename: Muge
authors.initials: M
authors.lastname: Ayanoğlu
authors.affiliation: Pediatric Radiology, Dokuz Eylül University School of Medicine, İzmir, Turkey.
authors.forename: Tülay
authors.initials: T
authors.lastname: Öztürk
authors.affiliation: Pediatric Radiology, Dokuz Eylül University School of Medicine, İzmir, Turkey.
authors.forename: Handan
authors.initials: H
authors.lastname: Güleryüz
authors.affiliation: Departments of Pediatric Neurology, and.
authors.forename: Semra Hız
authors.initials: SH
authors.lastname: Kurul
mesh_terms: D000906:Antibodies / Q000097:blood*; D001921:Brain / Q000000981:diagnostic imaging; D002648:Child; D004359:Drug Therapy, Combination; D004673:Encephalomyelitis, Acute Disseminated / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000276:immunology*; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D008279:Magnetic Resonance Imaging; D008775:Methylprednisolone / Q000627:therapeutic use; D063308:Myelin-Oligodendrocyte Glycoprotein / Q000276:immunology*; D066127:White Matter / Q000000981:diagnostic imaging / Q000473:pathology*
chemical_list: D000906:Antibodies; D005938:Glucocorticoids; D016756:Immunoglobulins, Intravenous; D007166:Immunosuppressive Agents; D063308:Myelin-Oligodendrocyte Glycoprotein; D008775:Methylprednisolone