# Seizures as the initial manifestation: characterizing the adult phenotype of MOG antibody-associated disease

## TL;DR

This study examines adult patients with MOG antibody-associated disease who first experience seizures, highlighting the importance of early diagnosis and treatment.

## Contribution

The study identifies seizures as a potential initial symptom of MOG antibody disease in adults, emphasizing the need for early antibody testing.

## Key findings

- Seven adult MOG antibody-positive patients presented with seizures as the first symptom, with ages ranging from 18 to 75 years.
- MRI showed cortical lesions in some patients, while others had normal results, and EEG revealed focal slow waves in most cases.
- All patients improved with treatment, including corticosteroids or intravenous immunoglobulin, and one case experienced recurrence.

## Abstract

Clinical Characteristics of Adult MOG Antibody-Associated Disease Presenting with Seizures as the Initial Symptom.

A retrospective analysis was conducted on the clinical data of 7 patients who presented with epileptic seizures as the initial symptom among 16 adult MOG antibody-positive patients admitted to the Department of Neurology at Xingtai People’s Hospital in Hebei Province from August 2020 to March 2025.

In this study, the age of onset of the 7 patients ranged from 18 to 75 years. All patients presented with epileptic seizures as the initial symptom, with 3 cases accompanied by fever and 4 cases by headache. Among the 7 patients, seizure types included focal seizures and generalized tonic–clonic seizures. Cerebrospinal fluid (CSF) pressure was elevated in 4 cases, while leukocyte count was increased in 2 cases. Cranial magnetic resonance imaging (MRI) revealed cortical lesions in 3 patients without significant meningeal enhancement, and 4 cases showed no abnormal findings on MRI. Electroencephalography (EEG) revealed focal slow waves in 5 cases, while 2 cases showed normal findings. All 7 patients were treated with hormones, 2 received intravenous human immunoglobulin, and 5 were administered antiepileptic drugs. All 7 patients achieved favorable prognosis, with one case of recurrence.

In adult MOG antibody-positive patients presenting with epileptic seizures as the initial symptom, the disease can occur at any age without a clear sex predominance. These patients may present with non-specific clinical features such as fever, headache, and abnormalities in cerebrospinal fluid and electroencephalography. Some patients may exhibit isolated epileptic seizures. Cranial magnetic resonance imaging often reveals cortical signal abnormalities. For adult patients presenting with seizures as the first symptom, early MOG antibody testing is essential for a definitive diagnosis. Prompt initiation of corticosteroid or intravenous immunoglobulin therapy can effectively control disease progression.