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Associations between seizures and MRI in patients with anti-NMDAR encephalitis
Guanzhong Ni1,2, Wanrong Lin3, Xiaodong Cai4
1Department of Neurology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.
Objectives:
Seizures are a prominent feature of anti-N-methyl-d-aspartate receptor (anti-NMDAR) encephalitis. Nearly half of brain magnetic resonance image (MRI) results are abnormal. The aim of our study was to evaluate the associations between seizures and brain MRI results in patients with anti-NMDAR encephalitis.
Methods:
Patients with anti-NMDAR encephalitis were enrolled between January 2015 and December 2018. The patients included were divided into normal and abnormal MRI groups. Seizure outcomes and modified Rankin Scale scores at the 1-year follow-up were assessed. Seizure characteristics and outcomes were compared between groups.
Results:
Of 35 patients with anti-NMDAR encephalitis, 28 patients (80%) had reported seizures in the acute phase. Patients with abnormal MRI findings more frequently had focal seizures than patients with normal MRI findings (72.7% vs 17.6%, P < .01). The incidence of patients treated with 2 or more antiepileptic drugs was higher in the normal MRI group than in the abnormal MRI group (100% vs 45.4%, P < .01). The onset-immunotherapy time was shorter in the abnormal MRI group than in the normal MRI group (P < .05). There were no statistically significant differences in seizure outcomes between the normal and abnormal MRI groups (P > .05).
Conclusions:
Focal seizures were most common in patients with abnormal MRI lesions. In the acute stage of the disease, the abnormal MRI group was more likely than the normal MRI group to achieve seizure control. Abnormal MRI findings did not affect the overall good prognosis of patients with anti-NMDAR encephalitis with seizures.
Insights
In anti-N-methyl-d-aspartate receptor (anti-NMDAR) encephalitis, abnormal MRI findings correlate with focal seizures. Despite initial seizure control differences, abnormal MRI does not impact long-term prognosis in these patients.
Area of Science:
- Neurology
- Neuroimmunology
- Neuroradiology
Background:
- Anti-N-methyl-d-aspartate receptor (anti-NMDAR) encephalitis is an autoimmune disorder frequently presenting with seizures.
- Brain magnetic resonance imaging (MRI) abnormalities are common but their association with seizure characteristics and outcomes is not fully understood.
Purpose of the Study:
- To investigate the relationship between seizure characteristics and brain MRI findings in patients diagnosed with anti-NMDAR encephalitis.
- To assess how MRI findings influence seizure control and long-term outcomes in anti-NMDAR encephalitis.
Main Methods:
- Retrospective analysis of 35 patients with anti-NMDAR encephalitis from January 2015 to December 2018.
- Patients were categorized into normal and abnormal brain MRI groups.
- Seizure types, treatment, and modified Rankin Scale scores at 1-year follow-up were compared between groups.
Main Results:
- Eighty percent of patients experienced seizures during the acute phase.
- Abnormal MRI findings were associated with a higher incidence of focal seizures (72.7% vs 17.6%) and shorter onset-to-immunotherapy time.
- No significant differences in 1-year seizure outcomes were observed between MRI groups.
Conclusions:
- Focal seizures are more prevalent in anti-NMDAR encephalitis patients with abnormal MRI lesions.
- Patients with abnormal MRI may achieve quicker seizure control in the acute stage.
- Abnormal MRI findings do not adversely affect the overall favorable prognosis of anti-NMDAR encephalitis patients with seizures.
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