Peer-reviewed article
Myelin oligodendrocyte glycoprotein antibody-associated isolated seizures in children: a retrospective single-center case series
Kang Liu, Panhui Yu, Liyao Ma, Yubing Gong, Hongru Lu et al. ·
Summary
Written by AI, not yet AICS's view · claude-sonnet-5-5This is a retrospective case series from a single hospital describing children with isolated seizures linked to MOG antibody-associated disease (MOGAD), a rare immune-related brain condition. Of 172 children with positive MOG antibodies, 6 (3.4%) had isolated seizures. Their median age at onset was 7.5 years. All six had abnormal cerebrospinal fluid (CSF) cell counts, and none had abnormal brain MRI. All received immunotherapy and had favourable outcomes at final follow-up, with no seizure recurrence. The authors recommend early MOG antibody testing in school-age children with seizures, particularly focal motor seizures, when ESR and CSF cell counts are raised and there is no sign of encephalitis or focal deficits.
Key points
- 6 of 172 children with seropositive MOG antibodies (3.4%) met the criteria for isolated seizures.
- Median age at onset was 7.5 years (range 5–9), with a male-to-female ratio of 1:2.
- Five patients had focal seizures and two had status epilepticus. None had encephalopathy or focal neurological deficits.
- All six had CSF pleocytosis, five had raised ESR, and no patient had an abnormal cranial MRI.
- All patients received immunotherapy and had favourable outcomes with no seizure recurrence or later demyelinating events.
Limitations
The study has only six patients from one centre, is retrospective, and has no comparison group, so it cannot show how common the condition is or whether immunotherapy caused the good outcomes. The document does not state the country or the length of follow-up.
Abstract
Background and purpose Isolated seizures represent a distinct, rare, and underrecognized phenotype of myelin oligodendrocyte glycoprotein (MOG) antibody-associated disease (MOGAD). In recent years, documentation of this phenotype has been limited to sporadic reports, with dedicated case series being extremely scarce. This study aimed to describe the clinical characteristics of isolated seizures in pediatric patients with MOGAD. Methods We retrospectively reviewed the medical records of pediatric patients diagnosed with MOG antibody-associated isolated seizures between January 2019 and January 2026. Clinical manifestations, brain magnetic resonance imaging (MRI) findings, laboratory data, treatment regimens, and clinical outcomes were systematically analyzed. Results Among the cohort of 172 pediatric patients with seropositive MOG antibodies, 6 (3.4%) met the inclusion criteria for isolated seizures. The median age at onset was 7.5 years (range, 5–9 years), with a male-to-female ratio of 1:2. Clinically, 4 patients presented solely with epileptic seizures, while the other 2 patients had additional transient limb weakness or headache, respectively. Focal seizures were observed in 5 patients, including 3 with focal motor seizures; additionally, 2 cases experienced status epilepticus. No patients exhibited encephalopathy or focal neurological deficits. Four patients had peripheral blood leukocytosis (range, 11.9–26 × 10 9 /L), and five had elevated erythrocyte sedimentation rates (ESR; range, 22–43 mm/h). All six patients showed cerebrospinal fluid (CSF) pleocytosis (41.1 ± 20.4/μL; range, 15–69/μL) without detectable infectious pathogens. Abnormal electroencephalogram (EEG) findings, including abnormal background activity and focal slow waves, were identified in 3 patients. No cranial MRI abnormalities were detected in any patient. All patients received immunotherapy, with one patient additionally receiving anti-seizure medications (ASMs). At final follow-up, all patients had favorable outcomes, with no recurrence of seizures or subsequent demyelinating events. Conclusion Myelin oligodendrocyte glycoprotein antibody-associated isolated seizures is a rare and frequently underrecognized phenotype within the spectrum of MOGAD. For school-age children presenting with epileptic seizures, particularly focal motor seizures, along with elevated ESR and CSF pleocytosis, early testing for MOG antibody is recommended in the absence of clinical or radiological evidence of encephalitis or focal neurological deficits. Most patients achieve favorable clinical outcomes, which may be partially attributed to immunotherapy. However, the efficacy of immunotherapy in preventing seizure recurrence, subsequent demyelinating events, and subclinical radiological disease remains indeterminate.