Distinct Cerebral F-FDG PET Metabolic Patterns in Anti-N-methyl-D-aspartate Receptor Encephalitis Patients with Different Trigger Factors

Overview

Journal Ther Adv Neurol Disord

Specialty Neurology

Date 2021 Mar 15

PMID 33717212

Citations 7

Authors

Jingjie Ge

Bo Deng

Yihui Guan

Weiqi Bao

Ping Wu

Xiangjun Chen

Chuantao Zuo

Affiliations

Soon will be listed here.

Abstract

Aim: Anti-N-methyl-D-aspartate receptor (anti-NMDAR) encephalitis is a subgroup of treatable autoimmune encephalitis, characterized by rapid development of psychosis, cognitive impairments and seizures. Etiologically, anti-NMDAR encephalitis could be divided into three subgroups, which are paraneoplastic (especially associated with ovarian teratoma), viral encephalitis-related and cryptogenic. Each type is different in clinical course, treatment strategies and prognosis. In this study, we aim to investigate whether anti-NMDAR encephalitis patients with different trigger factors exhibit distinct cerebral metabolic patterns detected by F-fluorodeoxyglucose positron emission tomography imaging.

Methods: 24 patients with anti-NMDAR encephalitis in acute phase from Huashan Hospital, Fudan University (Shanghai, China) were recruited in this study. Each patient was classified into one of etiological subgroups. Positron emission tomography images of individual patients were analyzed with both routine visual reading and computer-supported reading by comparison with those of the same 10 healthy controls using a voxel-wise statistical parametric mapping analysis.

Results: Patients in both the cryptogenic (13 patients) and paraneoplastic (five patients) subgroups showed hypermetabolism in the frontal-temporal lobes and basal ganglia, covarying with hypometabolism in the occipital regions. Notably, the abnormal metabolism was usually asymmetric in the cryptogenic subgroup, but relatively symmetric in the paraneoplastic subgroup. Moreover, the other six patients secondary to viral encephalitis presented with significant hypometabolism in the bilateral occipital regions, as well as in the unilateral temporal lobes and part of basal ganglia (also is virus infection side), but hypermetabolism in the contralateral temporal areas.

Conclusion: This study revealed that patients with anti-NMDAR encephalitis triggered by different factors presented distinct cerebral metabolic patterns. Awareness of these patterns may help to better understand the varying occurrence and development of anti-NMDAR encephalitis in each subgroup, and could offer valuable information to the early diagnosis, treatment and prognosis of this disorder.

Trial Registration Number: ChiCTR2000029115 (Chinese clinical trial registry site, http://www.chictr.org).

Citing Articles

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The clinical and predictive value of F-FDG PET/CT metabolic patterns in a clinical Chinese cohort with autoimmune encephalitis.

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Brain Metabolic Alterations in Seropositive Autoimmune Encephalitis: An F-FDG PET Study.

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References

Ladepeche L, Planaguma J, Thakur S, Suarez I, Hara M, Borbely J . NMDA Receptor Autoantibodies in Autoimmune Encephalitis Cause a Subunit-Specific Nanoscale Redistribution of NMDA Receptors. Cell Rep. 2018; 23(13):3759-3768. PMC: 6060408. DOI: 10.1016/j.celrep.2018.05.096. View

Kreye J, Wenke N, Chayka M, Leubner J, Murugan R, Maier N . Human cerebrospinal fluid monoclonal N-methyl-D-aspartate receptor autoantibodies are sufficient for encephalitis pathogenesis. Brain. 2016; 139(Pt 10):2641-2652. DOI: 10.1093/brain/aww208. View

Baumgartner A, Rauer S, Mader I, Meyer P . Cerebral FDG-PET and MRI findings in autoimmune limbic encephalitis: correlation with autoantibody types. J Neurol. 2013; 260(11):2744-53. DOI: 10.1007/s00415-013-7048-2. View

Yuan J, Guan H, Zhou X, Niu N, Li F, Cui L . Changing Brain Metabolism Patterns in Patients With ANMDARE: Serial 18F-FDG PET/CT Findings. Clin Nucl Med. 2016; 41(5):366-70. DOI: 10.1097/RLU.0000000000001164. View

Probasco J, Solnes L, Nalluri A, Cohen J, Jones K, Zan E . Abnormal brain metabolism on FDG-PET/CT is a common early finding in autoimmune encephalitis. Neurol Neuroimmunol Neuroinflamm. 2017; 4(4):e352. PMC: 5442608. DOI: 10.1212/NXI.0000000000000352. View

Suh-Lailam B, Haven T, Copple S, Knapp D, Jaskowski T, Tebo A . Anti-NMDA-receptor antibody encephalitis: performance evaluation and laboratory experience with the anti-NMDA-receptor IgG assay. Clin Chim Acta. 2013; 421:1-6. DOI: 10.1016/j.cca.2013.02.010. View

Venkatesan A, Tunkel A, Bloch K, Lauring A, Sejvar J, Bitnun A . Case definitions, diagnostic algorithms, and priorities in encephalitis: consensus statement of the international encephalitis consortium. Clin Infect Dis. 2013; 57(8):1114-28. PMC: 3783060. DOI: 10.1093/cid/cit458. View

Graus F, Titulaer M, Balu R, Benseler S, Bien C, Cellucci T . A clinical approach to diagnosis of autoimmune encephalitis. Lancet Neurol. 2016; 15(4):391-404. PMC: 5066574. DOI: 10.1016/S1474-4422(15)00401-9. View

Leypoldt F, Buchert R, Kleiter I, Marienhagen J, Gelderblom M, Magnus T . Fluorodeoxyglucose positron emission tomography in anti-N-methyl-D-aspartate receptor encephalitis: distinct pattern of disease. J Neurol Neurosurg Psychiatry. 2012; 83(7):681-6. PMC: 3740122. DOI: 10.1136/jnnp-2011-301969. View

10.

Dalmau J, Graus F . Antibody-Mediated Encephalitis. N Engl J Med. 2018; 378(9):840-851. DOI: 10.1056/NEJMra1708712. View

11.

Davies G, Irani S, Coltart C, Ingle G, Amin Y, Taylor C . Anti-N-methyl-D-aspartate receptor antibodies: a potentially treatable cause of encephalitis in the intensive care unit. Crit Care Med. 2009; 38(2):679-82. DOI: 10.1097/CCM.0b013e3181cb0968. View

12.

Gresa-Arribas N, Titulaer M, Torrents A, Aguilar E, McCracken L, Leypoldt F . Antibody titres at diagnosis and during follow-up of anti-NMDA receptor encephalitis: a retrospective study. Lancet Neurol. 2013; 13(2):167-77. PMC: 4006368. DOI: 10.1016/S1474-4422(13)70282-5. View

13.

Armangue T, Moris G, Cantarin-Extremera V, Conde C, Rostasy K, Erro M . Autoimmune post-herpes simplex encephalitis of adults and teenagers. Neurology. 2015; 85(20):1736-43. PMC: 4653102. DOI: 10.1212/WNL.0000000000002125. View

14.

Kayser M, Dalmau J . Anti-NMDA Receptor Encephalitis in Psychiatry. Curr Psychiatry Rev. 2014; 7(3):189-193. PMC: 3983958. DOI: 10.2174/157340011797183184. View

15.

Kerik-Rotenberg N, Diaz-Meneses I, Hernandez-Ramirez R, Munoz-Casillas R, Reynoso-Mejia C, Flores-Rivera J . A Metabolic Brain Pattern Associated With Anti-N-Methyl-D-Aspartate Receptor Encephalitis. Psychosomatics. 2019; 61(1):39-48. DOI: 10.1016/j.psym.2019.08.007. View

16.

Yue X, Xin Y, Chugani H, Chugani D, Zhang S . Automated production of a N-methyl-D-aspartate receptor radioligand [F]GE179 for clinical use. Appl Radiat Isot. 2019; 148:246-252. DOI: 10.1016/j.apradiso.2019.03.035. View

17.

Novy J, Allenbach G, Bien C, Guedj E, Prior J, Rossetti A . FDG-PET hyperactivity pattern in anti-NMDAr encephalitis. J Neuroimmunol. 2016; 297:156-8. DOI: 10.1016/j.jneuroim.2016.05.016. View

18.

Tripathi M, Tripathi M, Roy S, Parida G, Ihtisham K, Dash D . Metabolic topography of autoimmune non-paraneoplastic encephalitis. Neuroradiology. 2017; 60(2):189-198. DOI: 10.1007/s00234-017-1956-2. View

19.

Dalmau J, Lancaster E, Martinez-Hernandez E, Rosenfeld M, Balice-Gordon R . Clinical experience and laboratory investigations in patients with anti-NMDAR encephalitis. Lancet Neurol. 2010; 10(1):63-74. PMC: 3158385. DOI: 10.1016/S1474-4422(10)70253-2. View

20.

Ge J, Wu P, Peng S, Yu H, Zhang H, Guan Y . Assessing cerebral glucose metabolism in patients with idiopathic rapid eye movement sleep behavior disorder. J Cereb Blood Flow Metab. 2015; 35(12):2062-9. PMC: 4671128. DOI: 10.1038/jcbfm.2015.173. View