Median age of onset: 11.84 years, All had psychiatric behavior or cognitive dysfunction, 68.8% had involuntary movement, 37.5% had seizures, 75% had speech dysfunction, 50% had decreased level of consciousness, and 37.5% had autonomic dysfunction/central hypoventilation, Atypical symptoms included visual impairment, cerebellar ataxia, paralysis, impaired brainstem function, All had supratentorial demyelination on brain MRI; some had additional infratentorial lesions, High rate of MOG-IgG positivity (68.8%). Here, MOG is linked to Abnormal autonomic nervous system physiology.