A 26-year-old woman presented at age 7 with acute disseminated encephalomyelitis (ADEM), followed by recurrent episodes of optic neuritis at an interval of 6 months to 3 years. At the time of her ADEM attack, she was found to have T2 hyperintense lesions in the bilateral cerebellar hemispheres and right occipital lobe with patchy enhancement. CSF was normal including total protein, cell counts, and no oligoclonal bands. She had her approximately sixth episode of optic neuritis 13 years after her initial attack, and then started natalizumab 15 years after her initial attack. At that time MRIs revealed only nonspecific T2 hyperintense lesions in the white matter of the frontal lobes and cerebellar volume loss. While on natalizumab a MOG-IgG was found to be positive with a titer of 1:40. She remained in remission on natalizumab for 4.5 years until a positive JC virus antibody prompted a change in treatment to intravenous immunoglobulin (IVIG).

The optimal treatment for MOG antibody disease has not yet been defined, although multiple sclerosis therapies are generally avoided. Here we report that natalizumab maintained prolonged remission in a patient with MOG antibody disease suggesting that natalizumab may not be harmful, and may actually have benefit in decreasing attacks.