{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T04:04:29Z","timestamp":1791345869036,"version":"4.3.1"},"reference-count":24,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,10,16]],"date-time":"2025-10-16T00:00:00Z","timestamp":1760572800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Immunol."],"abstract":"<jats:sec><jats:title>Introduction<\/jats:title><jats:p>The coexistence of the MOG antibody (MOG-ab) and NMDAR antibody (NMDAR-ab), which is known as the MOG-ab and NMDAR-ab overlapping syndrome (MNOS), is the most common in overlapping syndromes of neural autoantibodies. The study aimed to analyze the clinical features and outcomes in adult patients suffering from MNOS and investigate the mechanisms of the disorder.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Adult patients suffering from MNOS admitted to the Affiliated Brain Hospital of Nanjing Medical University from 2020 to 2024 was systematically reviewed. The clinical symptoms, laboratory data, imaging results, treatments, and prognoses were evaluated. Moreover, the clinical data of MNOS patients were compared with those of anti-NMDAR encephalitis (anti-NMDARE) patients and MOG antibody-associated disorders (MOGAD) patients, respectively.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The study identified 23 adult patients of MNOS. The study cohort comprised 20 males (86.96%) and 3 females (13.04%), with a mean age of onset of 36.17 \u00b1 11.21 years. Prodromal infection was observed in 9 patients (39.13%). Sleep disorder was most common (69.57%), followed by psychiatric disorder and cognitive impairment (65.22%), consciousness disorder (60.87%), seizures (56.52%), speech disorder (39.13%), and headache (39.13%). Radiologically, 5 patients (21.74%) had damage to the cerebral cortex and basal ganglia. 4 patients (17.39%) had damage to the brainstem. All patients received first-line immunotherapy, and 16 (69.57%) of these patients received second-line treatment and long-term immunotherapy. Across 23 clinical attacks, the median modified Rankin Scale score (mRS) improved from 3 [interquartile range (IQR): 3,4] pre-treatment to 1 (IQR: 0,1) post-treatment. Relapses occurred in 6 patients (26.09%). We selected 51 adult patients with anti-NMDARE and 30 adult patients with MOGAD who had onset during the same period as the control groups. In terms of gender, psychiatric disorder, and brainstem involvement, there were significant differences between the anti-NMDARE group and the MNOS group. Regarding visual impairment, limb weakness, deep white matter lesion, and QAlb, differences were observed between the MOGAD group and the MNOS group.<\/jats:p><\/jats:sec><jats:sec><jats:title>Discussion<\/jats:title><jats:p>When atypical clinical symptoms and imaging results appear, clinicians should consider the possibility of antibody overlap. During anti-NMDARE relapse, attention should be paid to whether anti-MOG antibodies are co-present.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fimmu.2025.1664666","type":"journal-article","created":{"date-parts":[[2025,10,16]],"date-time":"2025-10-16T05:31:26Z","timestamp":1760592686000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":6,"title":["Clinical features and prognosis of the adult patients positive for both N-methyl-d-aspartate receptor and myelin oligodendrocyte glycoprotein antibodies"],"prefix":"10.3389","volume":"16","author":[{"given":"Yifang","family":"Ma","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Binting","family":"Liu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaojiao","family":"Ci","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jie","family":"Lu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2025,10,16]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.1016\/S1474-4422(08)70224-2","article-title":"Anti-NMDA-receptor encephalitis: case series and analysis of the effects of antibodies","volume":"7","author":"Dalmau","year":"2008","journal-title":"Lancet Neurol"},{"key":"B2","doi-asserted-by":"publisher","DOI":"10.1016\/S1474-4422(12)70310-1","article-title":"Treatment and prognostic factors for long-term outcome in patients with anti-NMDA receptor encephalitis: an observational cohort study","volume":"12","author":"Titulaer","year":"2013","journal-title":"Lancet Neurol"},{"key":"B3","doi-asserted-by":"publisher","first-page":"89","DOI":"10.1038\/s41582-018-0112-x","article-title":"Myelin oligodendrocyte glycoprotein antibodies in neurological disease","volume":"15","author":"Reindl","year":"2019","journal-title":"Nat Rev Neurol"},{"key":"B4","doi-asserted-by":"publisher","first-page":"219","DOI":"10.1186\/s12974-016-0678-4","article-title":"Mapping autoantigen epitopes: molecular insights into autoantibody-associated disorders of the nervous system","volume":"13","author":"Sinmaz","year":"2016","journal-title":"J Neuroinflam"},{"key":"B5","doi-asserted-by":"publisher","first-page":"uxad109","DOI":"10.1093\/cei\/uxad109","article-title":"Myelin oligodendrocyte glycoprotein antibody and N-methyl-d-aspartate receptor antibody overlapping syndrome: insights from the recent case reports","volume":"215","author":"Du","year":"2023","journal-title":"Clin Exp Immunol"},{"key":"B6","doi-asserted-by":"publisher","first-page":"391","DOI":"10.1016\/S1474-4422(15)00401-9","article-title":"A clinical approach to diagnosis of autoimmune encephalitis","volume":"15","author":"Graus","year":"2016","journal-title":"Lancet Neurol"},{"key":"B7","doi-asserted-by":"publisher","DOI":"10.1016\/S1474-4422(22)00431-8","article-title":"Diagnosis of myelin oligodendrocyte glycoprotein antibody-associated disease: International MOGAD Panel proposed criteria","volume":"22","author":"Banwell","year":"2023","journal-title":"Lancet Neurol"},{"key":"B8","doi-asserted-by":"publisher","DOI":"10.1007\/s00415-017-8635-4","article-title":"Clinical spectrum and IgG subclass analysis of anti-myelin oligodendrocyte glycoprotein antibody-associated syndromes: a multicenter study","volume":"264","author":"Mariotto","year":"2017","journal-title":"J Neurol"},{"key":"B9","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0000000000009239","article-title":"Clinical significance of anti-NMDAR concurrent with glial or neuronal surface antibodies","volume":"94","author":"Martinez-Hernandez","year":"2020","journal-title":"Neurology"},{"key":"B10","doi-asserted-by":"publisher","DOI":"10.1002\/ana.24117","article-title":"Overlapping demyelinating syndromes and anti-NMDA receptor encephalitis","volume":"75","author":"Titulaer","year":"2014","journal-title":"Ann Neurol"},{"key":"B11","doi-asserted-by":"publisher","first-page":"e21238","DOI":"10.1097\/MD.0000000000021238","article-title":"Anti-NMDA receptor encephalitis concomitant with myelin oligodendrocyte glycoprotein antibody diseases: A retrospective observational study","volume":"99","author":"Du","year":"2020","journal-title":"Med (Baltimore)"},{"key":"B12","doi-asserted-by":"publisher","DOI":"10.1016\/j.msard.2018.01.007","article-title":"Comparison of myelin oligodendrocyte glycoprotein (MOG)-antibody disease and AQP4-IgG-positive neuromyelitis optica spectrum disorder (NMOSD) when they co-exist with anti-NMDA (N-methyl-D-aspartate) receptor encephalitis","volume":"20","author":"Fan","year":"2018","journal-title":"Mult Scler Relat Disord"},{"key":"B13","doi-asserted-by":"publisher","first-page":"262","DOI":"10.1007\/s00415-025-13011-5","article-title":"Clinical characterization of diseases associated with anti-N-methyl-D-aspartate receptor encephalitis combined with anti-myelin oligodendrocyte glycoprotein antibodies in adults","volume":"272","author":"Ding","year":"2025","journal-title":"J Neurol"},{"key":"B14","doi-asserted-by":"publisher","first-page":"63","DOI":"10.1016\/S1474-4422(10)70253-2","article-title":"Clinical experience and laboratory investigations in patients with anti-NMDAR encephalitis","volume":"10","author":"Dalmau","year":"2011","journal-title":"Lancet Neurol"},{"key":"B15","doi-asserted-by":"publisher","first-page":"102611","DOI":"10.1016\/j.msard.2020.102611","article-title":"Anti-NMDAR encephalitis may develop concurrently with anti-MOG antibody-associated bilateral medial frontal cerebral cortical encephalitis and relapse with elevated CSF IL-6 and CXCL13","volume":"47","author":"Fujimori","year":"2021","journal-title":"Mult Scler Relat Disord"},{"key":"B16","doi-asserted-by":"publisher","DOI":"10.1177\/1352458520951046","article-title":"MOG-IgG1 and co-existence of neuronal autoantibodies","volume":"27","author":"Kunchok","year":"2021","journal-title":"Mult Scler J"},{"key":"B17","doi-asserted-by":"publisher","DOI":"10.3389\/fneur.2023.1279211","article-title":"Clinical characteristics of Chinese pediatric patients positive for anti-NMDAR and MOG antibodies: a case series","volume":"14","author":"Kang","year":"2024","journal-title":"Front Neurol"},{"key":"B18","doi-asserted-by":"publisher","DOI":"10.3389\/fneur.2021.711376","article-title":"Clinical features of coexisting anti-NMDAR and MOG antibody-associated encephalitis: A systematic review and meta-analysis","volume":"12","author":"Ding","year":"2021","journal-title":"Front Neurol"},{"key":"B19","doi-asserted-by":"publisher","first-page":"261","DOI":"10.1186\/s12974-020-01824-2","article-title":"Cerebrospinal fluid findings in patients with myelin oligodendrocyte glycoprotein (MOG) antibodies. Part 1: Results from 163 lumbar punctures in 100 adult patients","volume":"17","author":"Jarius","year":"2020","journal-title":"J Neuroinflam"},{"key":"B20","doi-asserted-by":"publisher","DOI":"10.1007\/s00415-018-9122-2","article-title":"Neurological update: MOG antibody disease","volume":"266","author":"Wynford-Thomas","year":"2019","journal-title":"J Neurol"},{"key":"B21","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0000000000005560","article-title":"Clinical spectrum and prognostic value of CNS MOG autoimmunity in adults: The MOGADOR study","volume":"90","author":"Cobo-Calvo","year":"2018","journal-title":"Neurology"},{"key":"B22","doi-asserted-by":"publisher","DOI":"10.3760\/cma.j.cn113694-20250112-00023","article-title":"Chinese guidelines for diagnosis and treatment of myelin oligodendrocyte glycoprotein antibody-associated disease (2025 edition)","volume":"58","year":"2025","journal-title":"Chin J Neurol"},{"key":"B23","doi-asserted-by":"publisher","first-page":"931","DOI":"10.3760\/cma.j.cn113694-20220219-00118","article-title":"Chinese expert consensus on the diagnosis and management of autoimmune encephalitis (2022 edition)","volume":"55","year":"2022","journal-title":"Chin J Neurol"},{"key":"B24","doi-asserted-by":"publisher","DOI":"10.3389\/fneur.2019.01271","article-title":"Co-occurrence of anti-N-methyl-D-aspartate receptor encephalitis and anti-myelin oligodendrocyte glycoprotein inflammatory demyelinating diseases: A clinical phenomenon to be taken seriously","volume":"10","author":"Ren","year":"2019","journal-title":"Front Neurol"}],"container-title":["Frontiers in Immunology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fimmu.2025.1664666\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,16]],"date-time":"2025-10-16T05:31:28Z","timestamp":1760592688000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fimmu.2025.1664666\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,10,16]]},"references-count":24,"alternative-id":["10.3389\/fimmu.2025.1664666"],"URL":"https:\/\/doi.org\/10.3389\/fimmu.2025.1664666","relation":{},"ISSN":["1664-3224"],"issn-type":[{"value":"1664-3224","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,10,16]]},"article-number":"1664666"}}