PMID- 33171389
OWN - NLM
STAT- MEDLINE
DCOM- 20210514
LR  - 20210514
IS  - 1878-5883 (Electronic)
IS  - 0022-510X (Linking)
VI  - 419
DP  - 2020 Dec 15
TI  - Acute radiological features facilitate diagnosis and prognosis of 
      anti-N-methyl-d-aspartate receptor (NMDAR) and anti-voltage-gated potassium 
      channel (VGKC) encephalitis in adults.
PG  - 117216
LID - S0022-510X(20)30552-9 [pii]
LID - 10.1016/j.jns.2020.117216 [doi]
AB  - BACKGROUND: Anti-N-methyl-d-aspartate receptor (NMDAR) and anti-voltage-gated 
      potassium channel (VGKC) encephalitis are the commonest antibody-associated 
      autoimmune encephalitides (AIE). Acute clinical features have been 
      well-described, but data on the role of radiological findings in diagnosis and 
      prognosis of AIE are limited. METHODS: Anti-NMDAR and anti-VGKC encephalitis 
      patients from the National Neuroscience Institute were identified. We compared 
      clinical and paraclinical features, at acute presentation and on follow-up 
      between and within groups. RESULTS: Twenty-six anti-NMDAR and 11 anti-VGKC 
      encephalitis patients were reviewed. At acute presentation, dysautonomia (57.7%) 
      and impairment of consciousness (84.6%) occurred exclusively in anti-NMDAR 
      encephalitis. Cerebrospinal fluid pleocytosis was more common in anti-NMDAR 
      encephalitis (88.5% vs 20.0%, p = 0.003), while ictal electroencephalography 
      abnormalities were more frequent in anti-VGKC encephalitis (11.5% vs 45.5%, 
      p = 0.022). On acute imaging, leptomeningeal enhancement was seen only in 
      anti-NMDAR encephalitis (37.5%), while hippocampal T2 hyperintensities supported 
      the diagnosis of anti-VGKC encephalitis (63.6% vs 12.5%, p = 0.002). At follow-up 
      (median 53.0 months, range 13.0-119.0), anti-NMDAR encephalitis patients had 
      better modified Rankin scale scores (median 0.0 vs 3.0, p = 0.023). Relapses 
      occurred equally in both groups. Anti-VGKC encephalitis patients with abnormal 
      acute MRI were more likely to have poor outcomes compared to those with normal 
      imaging (100% vs 25%, p = 0.008), whereas acute imaging features in anti-NMDAR 
      encephalitis did not predict long-term outcomes. CONCLUSIONS: Acute MRI findings 
      can aid in early diagnosis and prognostication in suspected AIE. Leptomeningeal 
      enhancement in anti-NMDAR encephalitis and hippocampal lesions in anti-VGKC 
      encephalitis, together with typical clinical features, may allow distinction 
      between these antibody subtypes, and specific abnormal imaging features in 
      anti-VGKC encephalitis may be used as a prognostic marker.
CI  - Copyright (c) 2020 Elsevier B.V. All rights reserved.
FAU - Neo, Shermyn
AU  - Neo S
AD  - Department of Neurology, National Neuroscience Institute, Singapore. Electronic 
      address: shermyn.neo.x.m@singhealth.com.sg.
FAU - Yeo, Tianrong
AU  - Yeo T
AD  - Department of Neurology, National Neuroscience Institute, Singapore.
FAU - Chen, Zhiyong
AU  - Chen Z
AD  - Department of Neurology, National Neuroscience Institute, Singapore.
FAU - Ngiam, Nerice Heng Wen
AU  - Ngiam NHW
AD  - Department of Anaesthesiology, Singapore General Hospital, Singapore.
FAU - Lim, Ethanyn Tyen-Xin
AU  - Lim ET
AD  - Department of Diagnostic Radiology, National University Health System, Singapore.
FAU - Tan, Kevin
AU  - Tan K
AD  - Department of Neurology, National Neuroscience Institute, Singapore; Duke-NUS 
      Medical School, Singapore.
FAU - Lim, Tchoyoson Choie Cheio
AU  - Lim TCC
AD  - Duke-NUS Medical School, Singapore; Department of Neuroradiology, National 
      Neuroscience Institute, Singapore.
LA  - eng
PT  - Journal Article
DEP - 20201104
PL  - Netherlands
TA  - J Neurol Sci
JT  - Journal of the neurological sciences
JID - 0375403
RN  - 0 (Autoantibodies)
RN  - 0 (Potassium Channels, Voltage-Gated)
SB  - IM
MH  - Adult
MH  - *Anti-N-Methyl-D-Aspartate Receptor Encephalitis/complications/diagnostic imaging
MH  - Autoantibodies
MH  - Humans
MH  - Neoplasm Recurrence, Local
MH  - *Potassium Channels, Voltage-Gated
MH  - Prognosis
OTO - NOTNLM
OT  - Anti-NMDAR
OT  - Anti-VGKC
OT  - Autoimmune encephalitis
OT  - Magnetic resonance imaging
OT  - Outcomes
EDAT- 2020/11/11 06:00
MHDA- 2021/05/15 06:00
CRDT- 2020/11/10 20:13
PHST- 2020/09/02 00:00 [received]
PHST- 2020/10/27 00:00 [revised]
PHST- 2020/11/01 00:00 [accepted]
PHST- 2020/11/11 06:00 [pubmed]
PHST- 2021/05/15 06:00 [medline]
PHST- 2020/11/10 20:13 [entrez]
AID - S0022-510X(20)30552-9 [pii]
AID - 10.1016/j.jns.2020.117216 [doi]
PST - ppublish
SO  - J Neurol Sci. 2020 Dec 15;419:117216. doi: 10.1016/j.jns.2020.117216. Epub 2020 
      Nov 4.