Myelin Oligodendrocyte Glycoprotein Antibody-Associated Disease and COVID-19: A Systematic Review

Abstract

Background Myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) is an uncommon neurological disease affecting the central nervous system (CNS). Numerous neurological disorders, including multiple sclerosis (MS), neuromyelitis optica spectrum disorder (NMOSD), acute transverse myelitis (ATM), and MOGAD, have been reported following the COVID-19 infection during the current COVID-19 pandemic. On the other hand, it has been suggested that patients with MOGAD may be at greater risk for infection (particularly in the current pandemic). Objective In this systematic review, we gathered separately 1) MOGAD cases following COVID-19 infection as well as 2) clinical course of patients with MOGAD infected with COVID-19 based on case reports/series. Methods 329 articles were collected from 4 databases. These articles were conducted from inception to March 1st, 2022. Results Following the screening, exclusion criteria were followed and eventually, 22 studies were included. In 18 studies, a mean ± SD time interval of 18.6 ± 14.9 days was observed between infection with COVID-19 and the onset of MOGAD symptoms. Symptoms were partially or completely recovered in a mean of 67 days of follow-up. Among 4 studies on MOGAD patients, the hospitalization rate was 25%, and 15% of patients were hospitalized in the intensive care unit (ICU). Conclusion Our systematic review demonstrated that following COVID-19 infection, there is a rare possibility of contracting MOGAD. Moreover, there is no clear consensus on the susceptibility of MOGAD patients to severe COVID-19. However, obtaining deterministic results requires studies with a larger sample size.

Opsoclonus-Myoclonus-Ataxia Syndrome Due to Covid-19

“…Of note, the causal mechanisms of CNS involvement after SARS-CoV-2 infection are still under discussion, including direct virus-mediated tissue damage, a secondary pathway due to systemic effects such as hypoxia or cerebrovascular injury, but also tissue damage due to autoimmune mechanisms (Ellul et al, 2020;Jha et al, 2021) seem to play a crucial role. The nding of MOG-speci c antibody production identi ed in the present case is interesting, as MOG-speci c antibodies have been repeatedly reported in cases of encephalitis following SARS-CoV-2 infection (Durovic et al, 2021;Peters et al, 2021;Mirmosayyeb et al, 2023), but with different clinical and radiological features, including cognitive impairment, paresis and sensory disturbances, and diffuse cerebral hyperintensities and leptomeningeal enhancement on MRI. Observations in the patient reported here and in another paediatric case of MOG antibody-positive OMS following SARS-CoV-2 infection (Adhikari et al, 2021) suggest that OMS may be a rare manifestation of MOG antibody-associated encephalitis.…”

“…The present case illustrates an opsoclonus-myoclonus syndrome (OMS) in connection with a SARS-CoV-2 infection, which has been rarely reported before by other authors in the course of the Covid-19 pandemic. A causal relationship between OMS and the SARS-CoV-2 infection or the clinically de nable Covid-19 in the present case can be assumed, not only because of the temporal relationship (Mirmosayyeb et al, 2023), but also with regard to the CSF-analytical proof of antibody production against neural myelin protein (myelin oligodendrocyte glycoprotein; MOG). The striking cognitive impairment in this case are in line with numerous clinical observations of a parainfectious encephalopathy with an OMS following viral infection (Foucard et al, 2021).…”

“…In addition, normal brain MRI ndings in patients with neurological disorders including OMS associated with SARS-CoV-2 infections have been described in several reports (e.g. overview of Sriwastava et al, 2021, and also Mirmosayyeb et al, 2023).…”

“…MOG-antibody production has been observed in several cases of acute neurological diseases such as acute disseminated encephalomyelitis (ADEM), neuromyelitis optica spectrum disorders (NMOSD), or transverse myelitis (MY) associated with SARS-CoV-2 infection (Sriwastava et al, 2021), even at low MOG antibody titres (1:160) and normal cell counts in CFS (Sawalha et al, 2020). Immunosuppressive treatments with steroids, intravenous immunglobulins or monoclonal antibodies such as rituximab have been successfully administered in such cases (Oh et al, 2019;Foucard et al, 2021;Mirmosayyeb et al, 2023) and were considered in our case of OMS. However, the clinical course in our patient was favourable and the combined symptomatic treatment of myoclonus with levetiracetam, valproic acid, clonazepam and nally trihexphenidyl ultimately proved effective, as in similar cases (Levy and Chen, 2016), thus avoiding the need for prolonged immunosuppressive treatment after the initial administration of steroids.…”