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Clinical features and brain MRI volumetric changes in anti-mGluR5 encephalitis

Yueqian Sun1,2, James X Tao3, Xiong Han4

  • 1Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.

Annals of Clinical and Translational Neurology
|June 17, 2023
PubMed
Abstract

Insights

Anti-metabotropic glutamate receptor 5 (mGluR5) encephalitis presents with cognitive deficits, behavioral changes, and seizures. Amygdala enlargement on MRI is a key feature, and most patients experience good recovery.

Area of Science:

  • Neurology
  • Immunology
  • Neuroscience

Background:

  • Anti-metabotropic glutamate receptor 5 (mGluR5) encephalitis is a rare autoimmune neurological disorder.
  • It is often under-recognized, necessitating further characterization of its clinical and neuroimaging profiles.

Purpose of the Study:

  • To characterize the clinical manifestations of anti-mGluR5 encephalitis.
  • To identify distinct neuroimaging features, including volumetric changes, associated with the disease.

Main Methods:

  • Retrospective analysis of 29 patients with anti-mGluR5 encephalitis (15 new, 14 previously reported).
  • Clinical features were systematically documented.
  • Brain MRI volumetric analysis using FreeSurfer was performed on 9 new patients and compared with 25 healthy controls at early and chronic stages.

Main Results:

  • Common symptoms include cognitive deficits (72.4%), behavioral/mood disturbances (69%), seizures (55.2%), and sleep disorders (44.8%).
  • MRI revealed T2/FLAIR hyperintensities in mesiotemporal and subcortical regions in 75.9% of patients.
  • Significant amygdala enlargement was observed in both early and chronic stages compared to controls (P < 0.001).
  • Tumors were identified in 7 patients.

Conclusions:

  • Cognitive impairment, behavioral disturbances, seizures, and sleep disorders are prominent clinical features.
  • Anti-mGluR5 encephalitis generally has a good prognosis, with most patients achieving full recovery, even in paraneoplastic cases.
  • Amygdala enlargement represents a distinct MRI finding with potential implications for understanding disease processes.

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