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Hippocampal network abnormalities explain amnesia after VGKCC-Ab related autoimmune limbic encephalitis
Clare Loane1,2, Georgios P D Argyropoulos3, Adriana Roca-Fernández1
1Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK.
Journal of Neurology, Neurosurgery, and Psychiatry
|May 11, 2019
Summary
Limbic encephalitis causes lasting memory loss, with brain scans showing hippocampal atrophy and reduced connectivity. Functional connectivity, not just atrophy, predicts memory deficits in patients with voltage-gated potassium channel complex antibodies.
Area of Science:
- Neuroimmunology
- Neuroradiology
- Cognitive Neuroscience
Background:
- Limbic encephalitis associated with antibodies to voltage-gated potassium channel complex (VGKCC-Ab-LE) frequently results in hippocampal atrophy and persistent memory deficits.
- The long-term effects of VGKCC-Ab-LE on brain regions beyond the hippocampus and the correlation between brain damage and cognitive outcomes remain incompletely understood.
Purpose of the Study:
- To investigate the structural and functional brain abnormalities following VGKCC-Ab-LE.
- To determine the role of these abnormalities in residual memory impairment.
Main Methods:
- Cross-sectional study involving 24 VGKCC-Ab-LE patients and age/sex-matched healthy controls.
- Neuropsychological assessment, structural MRI (volumetry, voxel-based morphometry), and resting-state functional MRI (rs-fMRI) were employed.
- Analysis focused on hippocampal functional connectivity (FC) and associations between neuroimaging measures and memory performance.
Main Results:
- Patients exhibited selective memory impairment.
- Structural MRI revealed hippocampal atrophy, correlative atrophy in the mediodorsal thalamus, and reduced posteromedial cortex volume.
- Reduced posteromedial cortico-hippocampal and inter-hippocampal FC correlated significantly with memory scores, whereas regional volumes did not.
Conclusions:
- VGKCC-Ab-LE leads to persistent, isolated memory impairment.
- Brain abnormalities include hippocampal atrophy, reduced mediodorsal thalamic and posteromedial cortical volumes.
- Reduced functional connectivity of remaining hippocampal tissue is a stronger correlate of memory function than regional atrophy.
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