{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,23]],"date-time":"2025-12-23T05:24:47Z","timestamp":1766467487681,"version":"build-2065373602"},"reference-count":31,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2025,2,27]],"date-time":"2025-02-27T00:00:00Z","timestamp":1740614400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Neurology International"],"abstract":"<jats:p>MOGAD is a demyelinating syndrome with the presence of antibodies against myelin oligodendrocyte glycoprotein, which is, next to multiple sclerosis and the neuromyelitis optica spectrum, one of the manifestations of the demyelinating process, more common in the pediatric population. MOGAD can take a variety of clinical forms: acute disseminated encephalomyelitis (ADEM), retrobulbar optic neuritis, often binocular (ON), transverse myelitis (TM), or NMOSD-like course (neuromyelitis optica spectrum disorders), less often encephalopathy. The course may be monophasic (40\u201350%) or polyphasic (50\u201360%), especially with persistently positive anti-MOG antibodies. Very rarely, the first manifestation of the disease, preceding the typical symptoms of MOGAD by 8 to 48 months, is focal seizures with secondary generalization, without typical demyelinating changes on MRI of the head. The paper presents a case of a 17-year-old patient whose first symptoms of MOGAD were focal epileptic seizures in the form of turning the head to the right with the elevation of the left upper limb and salivation. Seizures occurred after surgical excision of a tumor of the right adrenal gland (ganglioneuroblastoma). Then, despite a normal MRI of the head and the exclusion of onconeural antibodies in the serum and cerebrospinal fluid after intravenous treatment, a paraneoplastic syndrome was suspected. After intravenous steroid treatment and immunoglobulins, eight plasmapheresis treatments, and the initiation of antiepileptic treatment, the seizures disappeared, and no other neurological symptoms occurred for nine months. Only subsequent relapses of the disease with typical radiological and clinical picture (ADEM, MDEM, recurrent ON) allowed for proper diagnosis and treatment of the patient both during relapses and by initiating supportive treatment. The patient\u2019s case allows us to analyze the multi-phase, clinically diverse course of MOGAD and, above all, indicates the need to expand the diagnosis of epilepsy towards demyelinating diseases: determination of anti-MOG and anti-AQP4 antibodies.<\/jats:p>","DOI":"10.3390\/neurolint17030037","type":"journal-article","created":{"date-parts":[[2025,2,27]],"date-time":"2025-02-27T05:13:58Z","timestamp":1740633238000},"page":"37","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Confusing Onset of MOGAD in the Form of Focal Seizures"],"prefix":"10.3390","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7270-9631","authenticated-orcid":false,"given":"Ma\u0142gorzata","family":"J\u0105czak-Go\u017adziak","sequence":"first","affiliation":[{"name":"Department of Developmental Neurology, Poznan University of Medical Sciences, 61-701 Pozna\u0144, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9839-8162","authenticated-orcid":false,"given":"Barbara","family":"Steinborn","sequence":"additional","affiliation":[{"name":"Department of Developmental Neurology, Poznan University of Medical Sciences, 61-701 Pozna\u0144, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,2,27]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Sechi, E., Cacciaguerra, L., Chen, J.J., Mariotto, S., Fadda, G., Dinoto, A., Lopez-Chiriboga, A.S., Pittock, S.J., and Flanagan, E.P. (2022). Myelin Oligodendrocyte Glycoprotein Antibody-Associated Disease (MOGAD): A Review of Clinical and MRI Features, Diagnosis, and Management. Front. Neurol., 13.","DOI":"10.3389\/fneur.2022.885218"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"2","DOI":"10.1016\/j.ejpn.2020.10.006","article-title":"E.U. pediatric MOG consortium consensus: Part 1\u2014Classification of clinical phenotypes of pediatric myelin oligodendrocyte glycoprotein antibody-associated disorders","volume":"29","author":"Bruijstens","year":"2020","journal-title":"Eur. J. Paediatr. Neurol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"4132","DOI":"10.1007\/s00415-023-11737-8","article-title":"Myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD): Current understanding and challenges","volume":"270","author":"Chen","year":"2023","journal-title":"J. Neurol."},{"key":"ref_4","first-page":"e68563","article-title":"Aggressive Course of Myelin Oligodendrocyte Glycoprotein Antibody-Associated Disease (MOGAD): An Illustration of Two Cases and Review of Literature","volume":"16","author":"Frade","year":"2024","journal-title":"Cureus"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"14","DOI":"10.1016\/j.ejpn.2020.10.002","article-title":"E.U. pediatric MOG consortium consensus: Part 2\u2014Neuroimaging features of pediatric myelin oligodendrocyte glycoprotein antibody-associated disorders","volume":"29","author":"Baumann","year":"2020","journal-title":"Eur. J. Paediatr. Neurol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"41","DOI":"10.1016\/j.ejpn.2020.10.005","article-title":"E.U. pediatric MOG consortium consensus: Part 5\u2014Treatment of pediatric myelin oligodendrocyte glycoprotein antibody-associated disorders","volume":"29","author":"Bruijstens","year":"2020","journal-title":"Eur. J. Paediatr. Neurol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"2329048X221079093","DOI":"10.1177\/2329048X221079093","article-title":"Refractory MOG-Associated Demyelinating Disease in a Pediatric Patient","volume":"9","author":"Kroenke","year":"2022","journal-title":"Child Neurol. Open"},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Zhao, C., Li, A., Liu, L., Wang, J., and Fan, D. (2020). Acute Myelitis, Recurrent Optic Neuritis, and Seizures Over 17 Years. Front. Neurol., 11.","DOI":"10.3389\/fneur.2020.541146"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"610","DOI":"10.1111\/dmcn.14032","article-title":"Isolated seizures during the first episode of relapsing myelin oligodendrocyte glycoprotein antibody-associated demyelination in children","volume":"61","author":"Ramanathan","year":"2019","journal-title":"Dev. Med. Child Neurol."},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Tenembaum, S., Yeh, E.A., and Guthy-Jackson Foundation International Clinical Consortium (GJCF-ICC) (2020). Pediatric NMOSD:A Review and Position Statement on Approach to Work-Up and Diagnosis. Front. Pediatr., 8.","DOI":"10.3389\/fped.2020.00339"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"456","DOI":"10.1016\/j.braindev.2023.05.002","article-title":"Myelin oligodendrocyte glycoprotein antibody-associated disease in a patient with symptoms of aseptic meningitis who achieved spontaneous remission: A case report and review of the literature","volume":"45","author":"Kawai","year":"2023","journal-title":"Brain Dev."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"104126","DOI":"10.1016\/j.msard.2022.104126","article-title":"Myelin oligodendrocyte glycoprotein antibody-associated aseptic meningitis without neurological parenchymal lesions: A novel phenotype","volume":"68","author":"Lin","year":"2022","journal-title":"Mult. Scler. Relat. Disord."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"3319","DOI":"10.2169\/internalmedicine.2845-19","article-title":"Aseptic Meningitis as an Initial Manifestation of Anti-myelin Oligodendrocyte Glycoprotein Antibody-associated Disease","volume":"58","author":"Suzuki","year":"2019","journal-title":"Intern. Med."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"577653","DOI":"10.1016\/j.jneuroim.2021.577653","article-title":"Aseptic meningitis and leptomeningeal enhancement associated with anti-MOG antibodies: A review","volume":"358","author":"Gombolay","year":"2021","journal-title":"J. Neuroimmunol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"731","DOI":"10.1038\/s41390-024-03058-x","article-title":"Less common phenotypes of myelin oligodendrocyte glycoprotein antibody-related diseases in children deserve more attention","volume":"96","author":"Wang","year":"2024","journal-title":"Pediatr. Res."},{"key":"ref_16","first-page":"004596","article-title":"Myelin Oligodendrocyte Glycoprotein Antibody-Associated Disease (MOGAD) Initially Presenting as Septic Meningoencephalitis in a 16-Year-Old Male","volume":"11","author":"Karavassilis","year":"2024","journal-title":"Eur. J. Case Rep. Intern. Med."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"268","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":"ref_18","doi-asserted-by":"crossref","first-page":"e209321","DOI":"10.1212\/WNL.0000000000209321","article-title":"Validation of the 2023 International Diagnostic Criteria for MOGAD in a Selected Cohort of Adults and Children","volume":"103","author":"Varley","year":"2024","journal-title":"Neurology"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"103693","DOI":"10.1016\/j.autrev.2024.103693","article-title":"MOGAD: A comprehensive review of clinicoradiological features, therapy and outcomes in 4699 patients globally","volume":"24","author":"Trewin","year":"2025","journal-title":"Autoimmun. Rev."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"193","DOI":"10.1016\/S1474-4422(22)00520-8","article-title":"MOGAD comes of age with new criteria","volume":"22","author":"Graus","year":"2023","journal-title":"Lancet Neurol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"957","DOI":"10.1016\/j.neurol.2024.08.004","article-title":"What\u00a0s new in NMOSD and MOGAD?","volume":"180","author":"Marignier","year":"2024","journal-title":"Rev. Neurol."},{"key":"ref_22","first-page":"20552173241274610","article-title":"The positive predictive value of MOG-IgG testing based on the 2023 diagnostic criteria for MOGAD","volume":"10","author":"Nguyen","year":"2024","journal-title":"Mult. Scler. J. Exp. Transl. Clin."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"210","DOI":"10.5603\/PJNNS.a2021.0077","article-title":"Increasing role of imaging in differentiating MS from non-MS and defining indeterminate borderline cases","volume":"56","author":"Jakuszyk","year":"2022","journal-title":"Neurol. Neurochir. Pol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"2289","DOI":"10.1038\/s41433-024-03108-y","article-title":"MOG antibody-associated optic neuritis","volume":"38","author":"Jeyakumar","year":"2024","journal-title":"Eye"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"2173","DOI":"10.1111\/epi.17315","article-title":"Seizures and epilepsy in multiple sclerosis, aquaporin four antibody-positive neuromyelitis optica spectrum disorder, and myelin oligodendrocyte glycoprotein antibody-associated disease","volume":"63","author":"Li","year":"2022","journal-title":"Epilepsia"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"216","DOI":"10.1016\/j.seizure.2021.09.011","article-title":"Seizures in myelin oligodendrocyte glycoprotein antibody-associated disorders and related immune factors","volume":"92","author":"Liu","year":"2021","journal-title":"Seizure"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"281","DOI":"10.1016\/j.msard.2018.11.007","article-title":"Acute epileptic seizures in myelin oligodendrocyte glycoprotein encephalomyelitis and neuromyelitis optica spectrum disorder: A comparative cohort study","volume":"27","author":"Yao","year":"2019","journal-title":"Mult. Scler. Relat. Disord."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"102011","DOI":"10.1016\/j.msard.2020.102011","article-title":"Seizures and myelin oligodendrocyte glycoprotein (MOG) antibodies: Two paradigmatic cases and a review of the literature","volume":"41","author":"Foiadelli","year":"2020","journal-title":"Mult. Scler. Relat. Disord."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"875","DOI":"10.1007\/s00401-020-02132-y","article-title":"The pathology of central nervous system inflammatory demyelinating disease accompanying myelin oligodendrocyte glycoprotein autoantibody","volume":"139","author":"Guo","year":"2020","journal-title":"Acta Neuropathol."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"583","DOI":"10.1111\/epi.16824","article-title":"A hypothesis for the role of axon demyelination in seizure generation","volume":"62","author":"Garbelli","year":"2021","journal-title":"Epilepsia"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"3180","DOI":"10.1111\/epi.17424","article-title":"Acute symptomatic seizures secondary to myelin oligodendrocyte glycoprotein antibody-associated disease","volume":"63","author":"Montalvo","year":"2022","journal-title":"Epilepsia"}],"container-title":["Neurology International"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2035-8377\/17\/3\/37\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T16:43:25Z","timestamp":1760028205000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2035-8377\/17\/3\/37"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,2,27]]},"references-count":31,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2025,3]]}},"alternative-id":["neurolint17030037"],"URL":"https:\/\/doi.org\/10.3390\/neurolint17030037","relation":{},"ISSN":["2035-8377"],"issn-type":[{"type":"electronic","value":"2035-8377"}],"subject":[],"published":{"date-parts":[[2025,2,27]]}}}