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Brain MRI volumetric changes in the follow-up of patients with anti-NMDAr encephalitis
Clinical Neurology and Neurosurgery ( IF 1.9 ) Pub Date : 2021-08-28 , DOI: 10.1016/j.clineuro.2021.106908
Enrique Gomez-Figueroa 1 , Christian Garcia-Estrada 1 , Elma Paredes-Aragon 1 , Jorge Salado-Burbano 2 , Fernando Cortés-Enriquez 1 , Oscar Marrufo-Melendez 3 , Mariana Espinola-Nadurille 4 , Jesus Ramirez-Bermudez 4 , Verónica Rivas-Alonso 1 , Teresita Corona 5 , José Flores-Rivera 1
Affiliation  

Introduction

Autoimmune anti-NMDAr encephalitis is an antibody-mediated disorder characterized by psychiatric symptoms followed by decreased consciousness, dysautonomia and seizures. The pathophysiology of the disease is related to the internalization of NR1 subtype NMDA receptors and the dysfunction of structures where they are abundant (frontotemporal and insular regions). Some reports suggest the existence of cerebral atrophy in the follow-up of these patients, with conflicting evidence regarding its presence and usefulness as a marker of prognosis.

Methods

In a longitudinal, observational study, all patients with the diagnosis of definite anti-NMDAr autoimmune encephalitis with initial and control MRI studies were included. Conventional MR Brain acquisition was performed using a 3-Tesla Skyra MRI System. Automated brain segmental analysis was performed using the Volbrain volumetry system. The differences between baseline MRI volumetric characteristics and volumetric measures at follow-up was assessed.

Results

25 patients were included (mean age 26.6, SD 9.6). 44% were females. The mean time between the studies was 24 (SD 21.4, 3–24) months. Significant volume loss was identified in the total brain volume (− 0.02%, p = 0.029), cerebellar volume (− 0.27%, p = 0.048) and brainstem volume (− 0.16%, p = 0.021).

Conclusions

This study supports previous observations regarding volume loss in several brain regions of patients with antiNMDAr encephalitis. Further analyses are required to understand the role of treatment and severe clinical forms, as well as the relationship between volume loss and functional outcome.



中文翻译:

抗 NMDAr 脑炎患者随访脑 MRI 体积变化

介绍

自身免疫性抗 NMDA 脑炎是一种抗体介导的疾病,其特征是精神症状,随后是意识下降、自主神经功能障碍和癫痫发作。该疾病的病理生理学与 NR1 亚型 NMDA 受体的内化以及它们丰富的结构(额颞叶和岛叶区域)的功能障碍有关。一些报告表明在这些患者的随访中存在脑萎缩,但关于其存在和作为预后标志物的有用性的证据相互矛盾。

方法

在一项纵向观察性研究中,所有经初步和对照 MRI 研究诊断为明确的抗 NMDAr 自身免疫性脑炎的患者都被纳入。使用 3-Tesla Skyra MRI 系统进行常规 MR 脑采集。使用Volbrain容积系统进行自动脑节段分析。评估了基线 MRI 体积特征和随访时的体积测量值之间的差异。

结果

包括 25 名患者(平均年龄 26.6,SD 9.6)。44% 是女性。研究之间的平均时间为 24 (SD 21.4, 3-24) 个月。在总脑体积(- 0.02%,p = 0.029)、小脑体积(- 0.27%,p = 0.048)和脑干体积(- 0.16%,p = 0.021)中发现了显着的体积损失。

结论

这项研究支持先前关于抗 NMDAr 脑炎患者几个脑区容量减少的观察结果。需要进一步分析以了解治疗和严重临床形式的作用,以及容量损失和功能结果之间的关系。

更新日期:2021-09-03
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