FLAIR-hyperintense lesions in anti-MOG-associated encephalitis with seizures (FLAMES) presenting with psychosis and refractory seizures

Myelin oligodendrocyte glycoprotein antibody associated disease (MOGAD) is an idiopathic inflammatory demyelinating disease of the central nervous system commonly associated with optic neuritis, transverse myelitis, acute disseminated encephalomyelitis and cortical encephalitis. A somewhat rare and less recognized syndrome in MOGAD has been identified, and is characterized by cortical encephalitis and seizures with cortical FLAIR-hyperintense lesions on the MRI aptly termed FLAMES (FLAIR-hyperintense Lesions in Anti-MOG-associated Encephalitis with Seizures). We report a previously healthy middle-aged man who presented with focal seizures and status epilepticus refractory to initial interventions. He later developed headache, mood and behavioral changes and ultimately tested positive for anti-MOG antibody in the serum using a fixed cell-based assay. When his MRI was re-assessed in retrospect, it was determined to be in keeping with FLAMES.