Anti-NMDA receptor encephalitis and brain atrophy in children and adults: A quantitative study

Bassal, Frederick; Harwood, Matthew; Oh, Ann; Lundberg, Jaclyn N; Hoffman, Justin; Cornejo, Patricia; Chapple, Kristina; Hughes, Jeremy; Narayan, Ram

doi:10.1016/j.clinimag.2021.05.028

Cited by 8 publications

(4 citation statements)

References 12 publications

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“…During a 9-month follow-up, frontal cortical atrophy was found in patients with anti-NMDAR encephalitis ( 15 ). In a study of quantitative and qualitative analysis of gray matter in patients with anti-NMDAR encephalitis, the temporal lobe was the primary region exhibiting atrophy, and 74% of the patients had epileptic activity ( 36 ). The common abnormalities in PET imaging include hypermetabolism in the frontal and temporal lobes, and studies have shown that the degree of frontotemporal lobe damage is positively correlated with the severity of the disease ( 10 , 13 , 37 ).…”

Section: Discussionmentioning

confidence: 99%

Cerebral gray matter volume changes in patients with anti-N-methyl-D-aspartate receptor encephalitis: A voxel-based morphometry study

Long

Zhao

et al. 2022

Front. Neurol.

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Background:Anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis is an autoimmune disease with typical clinical features. Whether and how cerebral gray matter structural damage inherent to the disorder affects cognitive function in patients is still unclear. Therefore, this study aimed to explore the changes in cerebral gray matter volume and whether these alterations contribute to cognitive impairment and mood disorders.MethodsForty patients with anti-NMDAR encephalitis and forty healthy controls (HCs) matched for gender, age, and education were recruited. All participants underwent attention network tests (ANT), neuropsychological tests and magnetic resonance imaging (MRI). Voxel-based morphological analysis (VBM) and correlation analysis was performed on all participants. Finally, according to the course of disease, patients were divided into two groups: NMDARE_SD (short duration; course ≤ 2 years since diagnosis) and NMDARE_LD (long duration; course >2 years since diagnosis), to evaluate gray matter volume changes that differ as a function of disease course.ResultsCompared to HCs, patients with anti-NMDAR encephalitis showed decreased executive control ability and lower MoCA score, while increased anxiety and depression as reflected by HAMA and HAMD24 scores (all P < 0.05). In VBM analysis, patients showed decreased gray matter volume in bilateral thalamus, left medial prefrontal cortex (mPFC_L), left superior temporal gyrus (STG_L), and left rectus gyrus. In the analysis stratified by disease course, the NMDARE_LD group exhibited decreased gray matter volume in the left precuneus and right posterior cerebellar lobe compared to the NMDARE_SD group.ConclusionsPatients with anti-NMDAR encephalitis have cognitive, executive, and emotional dysfunction, and the sites of gray matter atrophy are concentrated in the thalamus, frontal lobe, and temporal lobe. These abnormalities may be involved in the process of cognitive and affective dysfunction.Patients with different courses of anti-NMDAR encephalitis have different brain atrophy sites. These results may help to clarify the contradiction between clinical and imaging manifestations of anti NMDAR encephalitis, which is worthy of further longitudinal studies.

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Section: Discussionmentioning

confidence: 99%

Cerebral gray matter volume changes in patients with anti-N-methyl-D-aspartate receptor encephalitis: A voxel-based morphometry study

Long

Zhao

et al. 2022

Front. Neurol.

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“…In our series, the incidence of AIS was about 0.87% with involvement of PICA in one case and CRAO in another one, and no cases of AIS were found in MIS-C group. Steroid treatment was deemed a plausible cause of brain atrophy, although outcomes of brain damage or inflammation cannot be excluded, as already reported in patients with a history of brain injury, systemic chronic inflammatory disorders, and autoimmune encephalitis, even at pediatric age [ 58 , 59 , 60 ].…”

Section: Discussionmentioning

confidence: 99%

Neurological Involvement in Children with COVID-19 and MIS-C: A Retrospective Study Conducted for More than Two Years in a Pediatric Hospital

et al. 2022

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This study aimed to evaluate the type and severity of neurological involvement in children with SARS-CoV-2 infection or multisystem inflammatory syndrome in children (MIS-C) and compare these findings between the two groups. Children hospitalized with the diagnosis of COVID-19 or MIS-C at Meyer Children’s Hospital between February 2020 and June 2022 were retrospectively studied. One hundred twenty-two patients were enrolled, 95 in the COVID-19 group and 27 in the MIS-C group. In the COVID-19 group, impairment of consciousness was found in 67.4% of patients, headache in 18.9% and about 16.8% of patients experienced seizures. In this group, three patients were diagnosed with arterial ischemic stroke and one patient was diagnosed with Guillain-Barré syndrome (GBS). In the MIS-C group, about 70% of patients experienced consciousness impairment, about 20% behavioral changes, and another 20% mood deflection. Neurological symptoms and signs were highly heterogeneous and could be differentiated in COVID-19 and MIS-C. Consciousness impairment remained the most frequent manifestation in both groups, potentially underlying an encephalopathy. We also highlight the importance of considering psychiatric symptoms in children with COVID-19 and/or MIS-C. Most neurological manifestations were mild in our series; however, severe complications such as ischemic stroke and GBS are worthy of note.

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“…Unfortunately, the search for the latter type of autoantibodies has become frequent only in recent years, thus data about the clinical picture of these patients are still incomplete. A limited recovery of cognitive functions in patients with anti-NMDAR encephalitis may also be secondary to a progressive cortical atrophy [ 73 ]. A quantitative volumetric analysis conducted in a recent study in both adult and pediatric patients, showed brain atrophy in the majority of patients (64%) [ 73 ].…”

Section: Discussionmentioning

confidence: 99%

“…A limited recovery of cognitive functions in patients with anti-NMDAR encephalitis may also be secondary to a progressive cortical atrophy [ 73 ]. A quantitative volumetric analysis conducted in a recent study in both adult and pediatric patients, showed brain atrophy in the majority of patients (64%) [ 73 ].…”

Section: Discussionmentioning

confidence: 99%

Neuropsychological Sequelae, Quality of Life and Adaptive Behavior in Children and Adolescents with Anti-NMDAR Encephalitis: A Narrative Review

et al. 2021

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Anti-N-methyl-d-aspartate receptor (anti-NMDAR) encephalitis is a rare autoimmune illness characterized by a constellation of often severe, but treatable, psychiatric and neurological symptoms. Whereas symptoms such as psychosis and bizarre and abnormal motor behavior are common in adults, pediatric patients typically present with behavioral changes, irritability and sleep dysfunction. The recovery phase is usually slow and may be associated with longstanding adaptive, behavioral and neuropsychological problems. Very few studies explored the cognitive and adaptive sequelae in children with anti-NMDAR encephalitis. The present review article suggests that, although most children and adolescents return to their daily life and previous activities, they may have a low quality of life and show neuropsychological sequelae involving language, memory, especially verbal memory, and attentional resources, even after several months from the hospital discharge. In particular, the available results reveal difficulties in cognitive skills involving executive functions. This impairment is considered the “core” of the cognitive profile of young patients with anti-NMDAR encephalitis. On the other hand, some cognitive skills, such as general intelligence, show good overall recovery over time. Additional neuropsychological research evaluating larger samples, more homogenous methods and longitudinal studies is required.

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Anti-NMDA receptor encephalitis and brain atrophy in children and adults: A quantitative study

Cited by 8 publications

References 12 publications

Cerebral gray matter volume changes in patients with anti-N-methyl-D-aspartate receptor encephalitis: A voxel-based morphometry study

Cerebral gray matter volume changes in patients with anti-N-methyl-D-aspartate receptor encephalitis: A voxel-based morphometry study

Neurological Involvement in Children with COVID-19 and MIS-C: A Retrospective Study Conducted for More than Two Years in a Pediatric Hospital

Neuropsychological Sequelae, Quality of Life and Adaptive Behavior in Children and Adolescents with Anti-NMDAR Encephalitis: A Narrative Review

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