Anti-MOG autoantibody-associated schizophreniform psychosis.

Katharina Von Zedtwitz,Kathrin Nickel,Horst Urbach,Andrea Schlump,Isabelle Matteit,Maike Michel,Kimon Runge,Katharina Domschke,Benjamin Berger,Ludger Tebartz Van Elst,Dominik Denzel,Dominique Endres,Bernd Feige,Harald Prüss,Miriam A Schiele

doi:10.1017/neu.2021.29

Abstract

Autoimmune mechanisms are related to disease development in a subgroup of patients with psychosis. The contribution of immunoglobulin G (IgG) antibodies against myelin oligodendrocyte glycoprotein (MOG) is mainly unclear in this context. Therefore, two patients with psychosis and anti-MOG antibodies - detected in fixed cell-based and live cell-based assays - are presented. Patient 1 suffered from late-onset psychosis with singular white matter lesions in magnetic resonance imaging (MRI) and intermittent electroencephalography (EEG)slowing. Patient 2 suffered from a chronic paranoid-hallucinatory disorder with intermittent confusional states, non-specific white matter alterations on MRI, a disorganised alpha rhythm on EEG, and elevated cerebrospinal fluid protein. Both patients had anti-MOG antibody titres of 1:320 in serum (reference < 1:20). The arguments for and against a causal role for anti-MOG antibodies are discussed. The antibodies could be relevant, but due to moderate titres, they may have caused a rather 'subtle clinical picture' consisting of psychosis instead of 'classical' MOG encephalomyelitis.

Highlights

Schizophreniform psychoses are severe mental disorders that often result in significant impairment of the quality of life (Owen et al, 2016; Dziwota et al, 2018)
The role of anti-myelin antibodies against myelin oligodendrocyte glycoprotein (MOG) in this context remained unclear, and they are usually not examined in the routine workup of patients with psychosis (Endres et al, 2020a; 2020b; Pollak et al, 2020)
Two cases of anti-MOG antibody-positive psychosis are presented in this article: Patient 1 had late-onset psychosis, non-specific white matter changes in the magnetic resonance imaging (MRI), and EEG slowing

Summary

Introduction

Schizophreniform psychoses are severe mental disorders that often result in significant impairment of the quality of life (Owen et al, 2016; Dziwota et al, 2018). The role of anti-myelin antibodies against MOG in this context remained unclear, and they are usually not examined in the routine workup of patients with psychosis (Endres et al, 2020a; 2020b; Pollak et al, 2020). Recent studies have reported relevant associations between antiMOG antibodies and optic neuritis, myelitis, brainstem encephalitis, and – predominantly in children – acute disseminated encephalomyelitis (ADEM)-like presentations (Mariotto et al, 2017; Waters et al, 2020). According to recommended indications for anti-MOG antibody testing, diagnostic examinations should show abnormalities in magnetic resonance imaging (MRI), cerebrospinal fluid (CSF), and electrophysiological investigations (Jarius et al, 2016a 2016b; 2018). Treatment approaches in acute attacks suggest the use of high-dose corticosteroids and plasma exchange; for maintenance therapy azathioprine, mycophenolate mofetil, or rituximab are used (Whittam et al, 2020)

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