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Brain magnetic resonance-imaging findings of anti-N-methyl-d-aspartate receptor encephalitis: a cohort follow-up study in Chinese patients

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Abstract

The aim of this report was to assess routine clinical brain magnetic resonance imaging (MRI) and its relation to clinical characteristics and disease prognosis. Anti-N-methyl-d-aspartate receptor (NMDAR) encephalitis patients were consecutively recruited from West China Hospital between October 1, 2011 and April 1, 2016. Brain MRI findings of 106 patients were analysed, and outcomes were assessed at 4, 8, and 12 months after discharge from the hospital using the modified Rankin scale (mRS). An MRI of the brain was normal in 52/106 (49.1%) patients and abnormal or atypical in 54/106 (50.9%) patients. The initial MRI was abnormal with T2 or fluid-attenuated inversion recovery (FLAIR) hyper-intensity signals in 20/106 (18.9%) patients. There were no statistically significant differences between the MRI findings and clinical presentations (seizure, hypoventilation, loss of consciousness, and tumour) (P > 0.05). Patients with normal MRIs were younger than patients with abnormal MRIs (P < 0.05). The mean mRS score at the 4-month follow-up was significantly higher in patients with abnormal MRIs than in patients with normal MRIs (P < 0.05). Brain MRI abnormalities are typically mild or unrelated to clinical symptoms, which is a clinico-radiological paradox of this type of immune encephalitis. Abnormal MRIs did not affect prognosis evaluated by mRS.

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References

  1. Dalmau J, Lancaster E, Martinez-Hernandez E, Rosenfeld MR, Balice-Gordon R (2011) Clinical experience and laboratory investigations in patients with anti-NMDAR encephalitis. Lancet Neurol 10:63–74

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  2. Dalmau J, Tuzun E, Wu HY, Masjuan J, Rossi JE, Voloschin A, Baehring JM, Shimazaki H, Koide R, King D, Mason W, Sansing LH, Dichter MA, Rosenfeld MR, Lynch DR (2007) Paraneoplastic anti-N-methyl-d-aspartate receptor encephalitis associated with ovarian teratoma. Ann Neurol 61:25–36

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  3. Graus F, Titulaer MJ, Balu R, Benseler S, Bien CG, Cellucci T, Cortese I, Dale RC, Gelfand JM, Geschwind M, Glaser CA, Honnorat J, Hoftberger R, Iizuka T, Irani SR, Lancaster E, Leypoldt F, Pruss H, Rae-Grant A, Reindl M, Rosenfeld MR, Rostasy K, Saiz A, Venkatesan A, Vincent A, Wandinger KP, Waters P, Dalmau J (2016) A clinical approach to diagnosis of autoimmune encephalitis. Lancet Neurol 15:391–404

    Article  PubMed  PubMed Central  Google Scholar 

  4. Irani SR, Bera K, Waters P, Zuliani L, Maxwell S, Zandi MS, Friese MA, Galea I, Kullmann DM, Beeson D, Lang B, Bien CG, Vincent A (2010) N-methyl-d-aspartate antibody encephalitis: temporal progression of clinical and paraclinical observations in a predominantly non-paraneoplastic disorder of both sexes. Brain: J Neurol 133:1655–1667

    Article  Google Scholar 

  5. Titulaer MJ, McCracken L, Gabilondo I, Armangue T, Glaser C, Iizuka T, Honig LS, Benseler SM, Kawachi I, Martinez-Hernandez E, Aguilar E, Gresa-Arribas N, Ryan-Florance N, Torrents A, Saiz A, Rosenfeld MR, Balice-Gordon R, Graus F, Dalmau J (2013) Treatment and prognostic factors for long-term outcome in patients with anti-NMDA receptor encephalitis: an observational cohort study. Lancet Neurol 12:157–165

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  6. Wang R, Guan HZ, Ren HT, Wang W, Hong Z, Zhou D (2015) CSF findings in patients with anti-N-methyl-d-aspartate receptor-encephalitis. Seizure 29:137–142

    Article  PubMed  Google Scholar 

  7. Wang W, Li JM, Hu FY, Wang R, Hong Z, He L, Zhou D (2016) Anti-NMDA receptor encephalitis: clinical characteristics, predictors of outcome and the knowledge gap in southwest China. Eur J Neurol 23:621–629

    Article  CAS  PubMed  Google Scholar 

  8. Bloch RF (1988) Interobserver agreement for the assessment of handicap in stroke patients. Stroke 19:1448

    Article  CAS  PubMed  Google Scholar 

  9. Heine J, Pruss H, Bartsch T, Ploner CJ, Paul F, Finke C (2015) Imaging of autoimmune encephalitis—relevance for clinical practice and hippocampal function. Neuroscience 309:68–83

    Article  CAS  PubMed  Google Scholar 

  10. Huang X, Fan C, Wu J, Ye J, Zhan S, Song H, Liu A, Su Y, Jia J (2015) Clinical analysis on anti-N-methyl-d-aspartate receptor encephalitis cases: Chinese experience. Int J Clin Exp Med 8:18927–18935

    PubMed  PubMed Central  Google Scholar 

  11. Wegner F, Wilke F, Raab P, Tayeb SB, Boeck AL, Haense C, Trebst C, Voss E, Schrader C, Logemann F, Ahrens J, Leffler A, Rodriguez-Raecke R, Dengler R, Geworski L, Bengel FM, Berding G, Stangel M, Nabavi E (2014) Anti-leucine rich glioma inactivated 1 protein and anti-N-methyl-d-aspartate receptor encephalitis show distinct patterns of brain glucose metabolism in 18F-fluoro-2-deoxy-d-glucose positron emission tomography. BMC Neurol 14:136

    Article  PubMed  PubMed Central  Google Scholar 

  12. Vitaliani R, Mason W, Ances B, Zwerdling T, Jiang Z, Dalmau J (2005) Paraneoplastic encephalitis, psychiatric symptoms, and hypoventilation in ovarian teratoma. Ann Neurol 58:594–604

    Article  PubMed  PubMed Central  Google Scholar 

  13. Tojo K, Nitta K, Ishii W, Sekijima Y, Morita H, Takahashi Y, Tanaka K, Ikeda S (2011) A young man with Anti-NMDAR encephalitis following Guillain-Barre syndrome. Case Rep Neurol 3:7–13

    Article  PubMed  PubMed Central  Google Scholar 

  14. Oyanguren B, Sanchez V, Gonzalez FJ, de Felipe A, Esteban L, Lopez-Sendon JL, Garcia-Barragan N, Martinez-San Millan J, Masjuan J, Corral I (2013) Limbic encephalitis: a clinical-radiological comparison between herpetic and autoimmune etiologies. Eur J Neurol 20:1566–1570

    Article  CAS  PubMed  Google Scholar 

  15. Titulaer MJ, Hoftberger R, Iizuka T, Leypoldt F, McCracken L, Cellucci T, Benson LA, Shu H, Irioka T, Hirano M, Singh G, Cobo Calvo A, Kaida K, Morales PS, Wirtz PW, Yamamoto T, Reindl M, Rosenfeld MR, Graus F, Saiz A, Dalmau J (2014) Overlapping demyelinating syndromes and anti-N-methyl-d-aspartate receptor encephalitis. Ann Neurol 75:411–428

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  16. Kruer MC, Koch TK, Bourdette DN, Chabas D, Waubant E, Mueller S, Moscarello MA, Dalmau J, Woltjer RL, Adamus G (2010) NMDA receptor encephalitis mimicking seronegative neuromyelitis optica. Neurology 74:1473–1475

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  17. Pennington C, Livingstone S, Santosh C, Razvi S (2012) N-methyl-d-aspartate receptor antibody encephalitis associated with myelitis. J Neurol Sci 317:151–153

    Article  PubMed  Google Scholar 

  18. Lekoubou A, Viaccoz A, Didelot A, Anastasi A, Marignier R, Ducray F, Rogemond V, Honnorat J (2012) Anti-N-methyl-d-aspartate receptor encephalitis with acute disseminated encephalomyelitis-like MRI features. Eur J Neurol 19:e16–e17

    Article  CAS  PubMed  Google Scholar 

  19. Finke C, Kopp UA, Scheel M, Pech LM, Soemmer C, Schlichting J, Leypoldt F, Brandt AU, Wuerfel J, Probst C, Ploner CJ, Pruss H, Paul F (2013) Functional and structural brain changes in anti-N-methyl-d-aspartate receptor encephalitis. Ann Neurol 74:284–296

    CAS  PubMed  Google Scholar 

  20. Peer M, Pruss H, Ben-Dayan I, Paul F, Arzy S, Finke C (2017) Functional connectivity of large-scale brain networks in patients with anti-NMDA receptor encephalitis: an observational study. Lancet Psychiatry 4:768–774

    Article  PubMed  Google Scholar 

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Acknowledgements

We are grateful to all people involved in the study. This work was supported by the National Natural Science Foundation of China (Grants 81671291, 30900471, and 81420108014) and the Sichuan Science and Technology Support Program (Project No 2013SZ0003).

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Author notes

  1. Rui Wang and Xiao-hui Lai contributed equally to the manuscript.

  2. Dong Zhou and Zhen Hong contributed equally to the manuscript.

Authors and Affiliations

  1. Department of Neurology, West China Hospital, Sichuan University, No. 37 Guoxue Road, Chengdu, Sichuan, 610041, People’s Republic of China

    Rui Wang, Xiao-hui Lai, Xu Liu, Yu-Jia Li, Chu Chen, Chen Li, Xiao-Sa Chi, Dong Zhou & Zhen Hong

  2. Department of Neurology, Pengzhou People’s Hospital, Chengdu, People’s Republic of China

    Rui Wang

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  1. Rui Wang
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  2. Xiao-hui Lai
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  4. Yu-Jia Li
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  5. Chu Chen
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  7. Xiao-Sa Chi
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  8. Dong Zhou
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  9. Zhen Hong
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Contributions

RW, HXL, DZ, and ZH conceptualized and designed the study. RW and HXL, XL, YL, C C, CL, and XC acquired the data. RW and ZH carried out the statistical analysis. RW, HXL, DZ, and ZH interpreted the data. RW, DZ, and ZH drafted the manuscript and all participated in the revision of the manuscript. DZ and ZH organized funding. ZH is the guarantor.

Corresponding author

Correspondence to Zhen Hong.

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None of the authors has any conflicts of interest to declare.

Ethical standards

The study was approved by the Research Ethics Committee of the Medical School of Sichuan University. All participants have provided written consent to participate in the study.

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Wang, R., Lai, Xh., Liu, X. et al. Brain magnetic resonance-imaging findings of anti-N-methyl-d-aspartate receptor encephalitis: a cohort follow-up study in Chinese patients. J Neurol 265, 362–369 (2018). https://doi.org/10.1007/s00415-017-8707-5

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  • DOI: https://doi.org/10.1007/s00415-017-8707-5

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