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Published on: January 9, 2018
Cerebral (18)FluoroDeoxy-Glucose Positron Emission Tomography in paediatric anti N-methyl-D-aspartate receptor
Stanislas Lagarde1, Anne Lepine1, Emilie Caietta1
1APHM, Timone Hospital, Paediatric Neurology Department, 13005 Marseille, France.
Insights
Cerebral FDG-PET imaging shows high sensitivity for diagnosing anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis in children. This study identified specific brain metabolism patterns, aiding in prompt diagnosis and treatment for this severe neurological condition.
Area of Science:
- Neurology
- Pediatric Neurology
- Neuroimmunology
Background:
- Anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis is a severe neurological disorder in children, often presenting with behavioral issues, seizures, and movement disorders.
- Early diagnosis and immunotherapy are crucial for favorable outcomes, but conventional diagnostic tests have limited sensitivity.
- Cerebral (18)FluoroDeoxy-Glucose Positron Emission Tomography (FDG-PET) shows promise in adults, but data in pediatric populations are scarce.
Observation:
- This retrospective study analyzed clinical, ancillary, and cerebral FDG-PET data from 6 pediatric patients with confirmed anti-NMDAR encephalitis.
- Patients exhibited typical severe clinical features, with four showing normal MRI results, highlighting diagnostic challenges.
- Cerebral FDG-PET was feasible and highly sensitive, detecting brain metabolism alterations in all 6 patients.
Findings:
- Specific FDG-PET patterns were observed in pediatric anti-NMDAR encephalitis: extensive symmetric cortical hypometabolism (especially posterior), asymmetric anterior hypermetabolism, and basal ganglia hypermetabolism.
- A strong correlation was found between clinical severity and observed changes in brain metabolism.
- Serial FDG-PET scans demonstrated parallel improvement in brain metabolism and clinical status, supporting treatment efficacy.
Implications:
- Cerebral FDG-PET imaging reveals distinct patterns of brain metabolism alteration in pediatric anti-NMDAR encephalitis.
- FDG-PET can be a valuable tool for early diagnosis and monitoring treatment response in children with this condition.
- Further research into FDG-PET patterns may improve diagnostic accuracy and therapeutic strategies for pediatric autoimmune encephalitis.
Background:
Anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis is a frequent and severe cause of encephalitis in children with potential efficient treatment (immunotherapy). Suggestive clinical features are behavioural troubles, seizures and movement disorders. Prompt diagnosis and treatment initiation are needed to guarantee favourable outcome. Nevertheless, diagnosis may be challenging because of the classical ancillary test (magnetic resonance imaging (MRI), electroencephalogram, standard cerebro-spinal fluid analysis) have limited sensitivity. Currently, immunological analyses are needed for the diagnostic confirmation. In adult patients, some studies suggested a potential role of cerebral (18)FluoroDeoxy-Glucose Positron Emission Tomography (FDG-PET) in the evaluation of anti-NMDAR encephalitis. Nevertheless, almost no data exist in paediatric population.
Method:
We report retrospectively clinical, ancillary tests and cerebral FDG-PET data in 6 young patients (median age=10.5 years, 4 girls) with immunologically confirmed anti-NMDAR encephalitis.
Results:
Our patients presented classical clinical features of anti-NMDAR encephalitis with severe course (notably four patients had normal MRI). Our series shows the feasibility and the good sensitivity of cerebral FDG-PET (6/6 patients with brain metabolism alteration) in paediatric population. We report some particular features in this population: extensive, symmetric cortical hypometabolism especially in posterior areas; asymmetric anterior focus of hypermetabolism; and basal ganglia hypermetabolism. We found also a good correlation between the clinical severity and the cerebral metabolism changes. Moreover, serial cerebral FDG-PET showed parallel brain metabolism and clinical improvement.
Conclusion:
Our study reveals the existence of specific patterns of brain metabolism alteration in anti-NMDAR encephalitis in paediatric population.
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