Objective:

To understand the neuropsychiatric manifestations and associated pathophysiology of anti-MOG disease.

Background:

Myelin Oligodendrocyte protein (MOG) is found on the surface of myelin sheaths in the central nervous system(CNS). IgG antibodies produced against MOG can produce a variety of pathological manifestations classified under anti-MOG disease. Anti-MOG disease is characterized by demyelination due to the destruction of MOG in the myelin sheath of the CNS. While anti-MOG disease is known to present with an array of neurological symptoms, little is known about the neuropsychiatric presentations of the disease.

Design/Methods:

We present 4 cases of anti-MOG disease with psychiatric manifestations.

Results:

All patients had positive and elevated titers for anti-MOG antibodies. Among psychiatric symptoms, hallucinations were reported in all patients.  Neurological symptoms were present in young women along with psychiatric manifestations. No neurological symptoms were reported in patients of the middle age group. Patients treated with immunosuppressive therapy had no recurrence of psychiatric symptoms whereas patients treated with antipsychotics experienced recurrence in stressful situations.

Conclusions:

We highlight the association of psychiatric symptoms in patients with elevated titers of anti-MOG antibodies. We also found that patients treated with immunosuppressants experienced better outcomes in terms of no relapse of psychiatric symptoms. It is important to know how many patients presenting with psychiatric symptoms might have anti-MOG antibodies and if the underlying pathology is immune-mediated which needs targeted immunotherapy instead of antipsychotics.