Association of Progressive Cerebellar Atrophy With Long-term Outcome in Patients With Anti-<i>N</i>-Methyl-<scp>d</scp>-Aspartate Receptor Encephalitis

Iizuka, Takahiro; Kaneko, Juntaro; Tominaga, Naomi; Someko, Hidehiro; Nakamura, Masaaki; Ishima, Daisuke; Kitamura, Eiji; Masuda, Ray; Oguni, Eiichi; Yanagisawa, Toshiyuki; Kanazawa, Naomi; Dalmau, Josep; Nishiyama, Kazutoshi

doi:10.1001/jamaneurol.2016.0232

Cited by 79 publications

(72 citation statements)

References 35 publications

(47 reference statements)

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“…We found that the median onset-to-MR time of the GCA (+) group was 60 which was higher than that of the GCA (-) group. A previous study demonstrated that brain atrophy in anti-NMDAR encephalitis started 1 to 2 month after symptom onset, which was consistent with our finding [7].…”

Section: Discussionsupporting

confidence: 93%

Encephalatrophy and anti-N-methyl-D-aspartate receptor encephalitis

Lin

et al. 2020

Preprint

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Objective: This study aims to find whether there are differences of clinical and laboratory features between anti-NMDAR encephalitis patients with and without brain atrophy. We also compare brain atrophy scale in anti-NMDAR positive patients with and without teratomas. Methods: Brain atrophy scales of 82 patients with anti-NMDAR encephalitis were measured with the median temporal lobe atrophy (MTA) scale and the global cortical atrophy (GCA) scale. They were divided into two groups by brain atrophy status. In addition, 48 female patients with anti-NMDAR encephalitis were divided into two groups with or without teratomas. Percentages of patients with brain atrophy were compared between these two groups. Results: 33 (40.2%) patients had brain atrophy. The GCA (+) group had higher percentage of patients with status epilepticus (p<0.001) than GCA (-) group and the MTA (+) group had higher percentage of patients with memory deficits (p < 0.001) than MTA (-) group. Higher percentages of severe infections were found in GCA(+) and MTA (+) groups than those in GCA(-) and MTA (-) groups (p=0.01 and p = 0.002, respectively). The percentage of patients needing ventilatory support was higher in MTA (+) group than that in MTA (-) group (p=0.015). The modified Rankin Scale (mRS) scores of GCA(+) and MTA (+) groups were significantly higher when compared with GCA(-) and MTA (-) groups both at day one (p<0.001 and p=0.001, respectively) and at discharge (p<0.001 and p = 0.02, respectively). Patients in GCA (+) group had higher median length of hospital stay than those in GCA (-) group (p<0.001). The median onset-to-MR time of GCA(+) group was higher than that of GCA(-) group (p=0.034). Percentage of patients with limited response to treatment was higher in GCA (+) group than that in GCA(-) group (p<0.001). The median 25 hydroxyvitamin D3 level was lower in the GCA (+) group than that in GCA(-) group (p=0.001). Anti-NMDAR positive female patients with ovarian teratomas had higher percentage of GCA(+) than thoes without ovarian teratomas (P=0.006). Conclusions: Brain atrophy are not uncommon in patients with anti-NMDAR encephalitis. MTA and GCA may be associated with severity and prognosis of anti-NMDAR encephalitis.

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Section: Discussionsupporting

confidence: 93%

Encephalatrophy and anti-N-methyl-D-aspartate receptor encephalitis

Lin

et al. 2020

Preprint

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“…Better functional outcome (mRS) at onset was associated with higher volume of the cerebellar gray matter. Such correlation in LGI1 encephalitis has not been described, but visually assessed irreversible cerebellar atrophy was associated with poor outcome in a recent study of NMDARencephalitis [37]. Better cognitive capacities measured by the ACE test at 23.4±7.6 months were also associated with higher putaminal volumes.…”

Section: Accepted Manuscript 12mentioning

confidence: 90%

Global brain atrophy and metabolic dysfunction in LGI1 encephalitis: A prospective multimodal MRI study

Szőts

Blaabjerg

Orsi

et al. 2017

Journal of the Neurological Sciences

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Background: Chronic cognitive deficits are frequent in leucin-rich glioma-inactivated 1 protein (LGI1) encephalitis. We examined structural and metabolic brain abnormalities following LGI1 encephalitis and correlated findings with acute and follow-up clinical outcomes. Methods:Nine patients underwent prospective multimodal 3 Tesla MRI 33.1±18 months after disease onset, including automated volumetry, diffusion tensor imaging (DTI) and magnetic resonance spectroscopy (MRS). Data were compared to 9 age-and sex-matched healthy controls. Conclusions:Poor clinical outcome following LGI1 encephalitis is associated with global brain atrophy and disintegration of white matter tracts. The pathological changes affect not only temporomesial structures but also frontal lobes and the cerebellum.

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“…However, in a clinical study with a median follow-up of 68 months, 33% of patients with DCA and some brain atrophy patients showed strong recoveries. Nevertheless, progressive cerebellar atrophy was irreversible, and in this study, cerebellar atrophy was strongly associated with a poor prognosis [49]. By using multimodal MRI, Finke et al found that the hippocampal connectivity and fractional anisotropy in the white matter of anti-NMDAR encephalitis patients were reduced, mainly the cingulate gyrus.…”

Section: Imagingmentioning

confidence: 46%

“…In addition to abnormal MRI findings, some patients can show reversible diffuse brain atrophy (DCA) and even brain atrophy, including progressive cerebellar atrophy. Studies have shown that DCA patients require more mechanical ventilation and have longer hospital stays [49]. However, in a clinical study with a median follow-up of 68 months, 33% of patients with DCA and some brain atrophy patients showed strong recoveries.…”

Section: Imagingmentioning

confidence: 96%

Current Progress on Assessing the Prognosis for Anti-N-Methyl-D-Aspartate Receptor (NMDAR) Encephalitis

Wang

Xiao

2020

BioMed Research International

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Anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis is the most common antineuronal antibody encephalitis in autoimmune encephalitis found at present. It has complex clinical manifestations such as psychiatric and behavioral abnormalities, seizures, movement disorders, consciousness, and autonomic dysfunction. The relationship between those manifestations and prognosis is unclear. Electroencephalography (EEG) is gradually becoming useful in the evaluation of the prognosis of anti-NMDAR encephalitis patients, while imaging and antibody testing have a limited prognostic value. Starting the patients on adequate treatments (such as immunotherapy) in a timely fashion has a positive impact on their prognosis. Nevertheless, research on the prognosis of anti-NMDAR encephalitis remains scarce. Here, we review the current advances of prognosis-related research from the clinical manifestations of the disease and auxiliary examinations such as EEG, magnetic resonance imaging (MRI), 18F fluorodeoxyglucose positron emission tomography (FDG-PET), and antibody measurement. In addition, we also discuss the impact of different treatment options on prognosis. In-depth research on the prognosis of patients with anti-NMDAR encephalitis will contribute to a better understanding of this disease, leading to better treatments options and, ultimately, a better prognosis.

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Association of Progressive Cerebellar Atrophy With Long-term Outcome in Patients With Anti-N-Methyl-d-Aspartate Receptor Encephalitis

Cited by 79 publications

References 35 publications

Encephalatrophy and anti-N-methyl-D-aspartate receptor encephalitis

Encephalatrophy and anti-N-methyl-D-aspartate receptor encephalitis

Global brain atrophy and metabolic dysfunction in LGI1 encephalitis: A prospective multimodal MRI study

Current Progress on Assessing the Prognosis for Anti-N-Methyl-D-Aspartate Receptor (NMDAR) Encephalitis

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