Multicenter Study

. 2023 May 26;10(4):e200130.

doi: 10.1212/NXI.0000000000200130. Print 2023 Jul.

MRI Features and Their Association With Outcomes in Children With Anti-NMDA Receptor Encephalitis

Grace Gombolay¹, J Nicholas Brenton², Jennifer H Yang², Coral M Stredny², Ryan Kammeyer², Catherine E Otten², NgocHanh Vu², Jonathan D Santoro², Karla Robles-Lopez², Andrew Christiana², Claude Steriade², Morgan Morris², Mark Gorman², Manikum Moodley², Duriel Hardy², Alexandra B Kornbluh², Ilana Kahn², Leigh N Sepeta², Anusha Yeshokumar²; Conquering Neuroinflammation and Epilepsies Consortium (CONNECT)

Affiliations

¹ From the Emory University SOM and Children's Healthcare of Atlanta (G.G., M. Morris); University of Virginia Health System (J.N.B.); University of California San Diego and Rady Children's Hospital San Diego (J.H.Y.); Boston Children's Hospital and Harvard Medical School (C.M.S., M.G.); University of Colorado SOM and Children's Hospital Colorado (R.K.); Seattle Children's/University of Washington (C.E.O.); Vanderbilt University Medical Center (N.V.); Children's Hospital Los Angeles and Keck School of Medicine (J.D.S.), University of Southern California; University of Texas at Austin and Dell Medical School (K.R.-L., M. Moodley, D.H.); New York University SOM (A.C., C.S.); Children's National Hospital and George Washington University Medical School (A.B.K., I.K., L.N.S.); Mount Sinai University and Bristol Myers Squibb (A.Y.). grace.yoonheekim.gombolay@emory.edu.
² From the Emory University SOM and Children's Healthcare of Atlanta (G.G., M. Morris); University of Virginia Health System (J.N.B.); University of California San Diego and Rady Children's Hospital San Diego (J.H.Y.); Boston Children's Hospital and Harvard Medical School (C.M.S., M.G.); University of Colorado SOM and Children's Hospital Colorado (R.K.); Seattle Children's/University of Washington (C.E.O.); Vanderbilt University Medical Center (N.V.); Children's Hospital Los Angeles and Keck School of Medicine (J.D.S.), University of Southern California; University of Texas at Austin and Dell Medical School (K.R.-L., M. Moodley, D.H.); New York University SOM (A.C., C.S.); Children's National Hospital and George Washington University Medical School (A.B.K., I.K., L.N.S.); Mount Sinai University and Bristol Myers Squibb (A.Y.).

PMID: 37236807
PMCID: PMC10219134
DOI: 10.1212/NXI.0000000000200130

Multicenter Study

MRI Features and Their Association With Outcomes in Children With Anti-NMDA Receptor Encephalitis

Grace Gombolay et al. Neurol Neuroimmunol Neuroinflamm. 2023.

. 2023 May 26;10(4):e200130.

doi: 10.1212/NXI.0000000000200130. Print 2023 Jul.

Authors

Affiliations

¹ From the Emory University SOM and Children's Healthcare of Atlanta (G.G., M. Morris); University of Virginia Health System (J.N.B.); University of California San Diego and Rady Children's Hospital San Diego (J.H.Y.); Boston Children's Hospital and Harvard Medical School (C.M.S., M.G.); University of Colorado SOM and Children's Hospital Colorado (R.K.); Seattle Children's/University of Washington (C.E.O.); Vanderbilt University Medical Center (N.V.); Children's Hospital Los Angeles and Keck School of Medicine (J.D.S.), University of Southern California; University of Texas at Austin and Dell Medical School (K.R.-L., M. Moodley, D.H.); New York University SOM (A.C., C.S.); Children's National Hospital and George Washington University Medical School (A.B.K., I.K., L.N.S.); Mount Sinai University and Bristol Myers Squibb (A.Y.). grace.yoonheekim.gombolay@emory.edu.
² From the Emory University SOM and Children's Healthcare of Atlanta (G.G., M. Morris); University of Virginia Health System (J.N.B.); University of California San Diego and Rady Children's Hospital San Diego (J.H.Y.); Boston Children's Hospital and Harvard Medical School (C.M.S., M.G.); University of Colorado SOM and Children's Hospital Colorado (R.K.); Seattle Children's/University of Washington (C.E.O.); Vanderbilt University Medical Center (N.V.); Children's Hospital Los Angeles and Keck School of Medicine (J.D.S.), University of Southern California; University of Texas at Austin and Dell Medical School (K.R.-L., M. Moodley, D.H.); New York University SOM (A.C., C.S.); Children's National Hospital and George Washington University Medical School (A.B.K., I.K., L.N.S.); Mount Sinai University and Bristol Myers Squibb (A.Y.).

PMID: 37236807
PMCID: PMC10219134
DOI: 10.1212/NXI.0000000000200130

Abstract

Objectives: How brain MRI lesions associate with outcomes in pediatric anti-NMDA receptor encephalitis (pNMDARE) is unknown. In this study, we correlate T2-hyperintense MRI brain lesions with clinical outcomes in pNMDARE.

Methods: This was a multicenter retrospective cohort study from 11 institutions. Children younger than 18 years with pNMDARE were included. One-year outcomes were assessed by the modified Rankin Score (mRS) with good (mRS ≤2) and poor (mRS ≥3) outcomes.

Results: A total of 175 pNMDARE subjects were included, with 1-year mRS available in 142/175 (81%) and 60/175 (34%) had abnormal brain MRIs. The most common T2-hyperintense lesion locations were frontal, temporal, and parietal. MRI features that predicted poor 1-year outcomes included abnormal MRI, particularly T2 lesions in the frontal and occipital lobes. After adjusting for treatment within 4 weeks of onset, improvement within 4 weeks, and intensive care unit admission, MRI features were no longer associated with poor outcomes, but after multiple imputation for missing data, T2 frontal and occipital lesions associated with poor outcomes.

Discussion: Abnormal frontal and occipital lesions on MRI may associate with 1-year mRS in pNMDARE. MRI of the brain may be a helpful prognostication tool that should be examined in future studies.

PubMed Disclaimer

Conflict of interest statement

G.Y. Gombolay, J.N. Brenton, J.H. Yang, C.M. Stredny, R. Kammeyer, C. Otten, N. Vu, J.D. Santoro, K. Robles-Lopez, A. Christiana, C. Steriade, M, Morris, M. Gorman, M. Moodley, D. Hardy, A. Kornbluh, I. Kahn, and L. Sepeta have no relevant disclosures. A. Yeshokumar is an employee of Bristol Myers Squibb but does not affect this study. Go to Neurology.org/NN for full disclosures.

Figures

**Figure. Flow Diagram of Pediatric Anti-NMDA Receptor Encephalitis Subjects Included and Excluded From This Study**

See this image and copyright information in PMC

References

1. Dalmau J, Armangue T, Planaguma J, et al. . An update on anti-NMDA receptor encephalitis for neurologists and psychiatrists: mechanisms and models. Lancet Neurol. 2019;18(11):1045-1057. - PubMed
1. Nosadini M, Eyre M, Molteni E, et al. . Use and safety of immunotherapeutic management of N-Methyl-d-aspartate receptor antibody encephalitis: a meta-analysis. JAMA Neurol. 2021;78(11):1333-1344. - PMC - PubMed
1. Zekeridou A, Karantoni E, Viaccoz A, et al. . Treatment and outcome of children and adolescents with N-methyl-D-aspartate receptor encephalitis. J Neurol. 2015;262(8):1859-1866. - PubMed
1. Titulaer MJ, McCracken L, Gabilondo I, et al. . Treatment and prognostic factors for long-term outcome in patients with anti-NMDA receptor encephalitis: an observational cohort study. Lancet Neurol. 2013;12(2):157-165. - PMC - PubMed
1. Li JH, Milla SS, Gombolay GY. Rate of anti-NMDA receptor encephalitis in ovarian teratomas. Neuropediatrics. 2021;53(2):133-135. - PMC - PubMed

Publication types

Actions
Actions
Actions

MeSH terms

Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions

Grants and funding

LinkOut - more resources

Full Text Sources

Save citation to file

Email citation

Add to Collections

Add to My Bibliography

Your saved search

Create a file for external citation management software

Your RSS Feed

MRI Features and Their Association With Outcomes in Children With Anti-NMDA Receptor Encephalitis

Affiliations

MRI Features and Their Association With Outcomes in Children With Anti-NMDA Receptor Encephalitis

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

References

Publication types

MeSH terms

Grants and funding

LinkOut - more resources

Full Text Sources