Brain magnetic resonance imaging as predictors in pediatric anti-N-methyl-D-aspartate receptor encephalitis

Area of Science:

• Pediatric Neurology
• Neuroimmunology
• Neuroradiology

Background:

• Anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis is a severe autoimmune neurological disorder.
• Understanding the neuroimaging characteristics and their clinical associations in pediatric patients is crucial for diagnosis and management.

Purpose of the Study:

• To investigate the associations between brain magnetic resonance imaging (MRI) changes and clinical profiles in children with anti-NMDAR encephalitis.
• To evaluate the prognostic value of initial and follow-up brain MRI findings.

Main Methods:

• Retrospective study of clinical data and brain MRI results from 143 children diagnosed with anti-NMDAR encephalitis.
• Analysis of initial brain MRI findings and their correlation with clinical symptoms, MOG antibodies, CSF WBC, and treatment.
• Assessment of brain MRI changes at last follow-up and their association with modified Rankin Scale (mRS) scores.

Main Results:

• 40.6% of patients had abnormal initial brain MRI, with temporal and frontal lobe lesions being common.
• Abnormal initial MRI was associated with fever, dystonia, positive MOG antibodies, and higher CSF WBC.
• No significant difference in mRS scores before or after immunotherapy between normal and abnormal initial MRI groups; no association with relapses.
• At last follow-up (median 25.5 months), 48.6% had abnormal brain MRI, which was associated with higher mRS scores.

Conclusions:

• Initial brain MRI abnormalities are present in about 40% of pediatric anti-NMDAR encephalitis cases and correlate with specific clinical features.
• Initial brain MRI findings are not predictive of relapse or long-term prognosis.
• Persistent or new MRI abnormalities at follow-up are associated with poorer functional outcomes (higher mRS scores).