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Whole brain MR spectroscopy in patients with anti-NMDAR encephalitis
Dominica Hudasch1, Nima Mahmoudi2,3, Xenyia Lisovska4
1Department of Neurology, Hannover Medical School, Hannover, Germany.
Objective:
To investigate neurometabolic alterations in patients who have had anti-N-methyl-D-aspartate-receptor (NMDAR) encephalitis using whole-brain magnetic resonance spectroscopic imaging (wbMRSI) in comparison to matched healthy volunteers with no history of anti-NMDAR encephalitis.
Methods:
Twenty patients with a history of anti-NMDAR encephalitis and 20 healthy controls underwent wbMRSI. The concentrations of the metabolites N-acetyl-aspartate (NAA), choline (Cho), total creatine (tCr), Myo-Inositol (ml) and Glutamate/Glutamine (Glx) were measured in both frontal lobes (LFL and RFL), both temporal lobes (LTL and RTL), both parietal lobes (LPL and RPL), both occipital lobes (LOL and ROL), and cerebellum and compared using two-sided t-tests. Additionally, each patient underwent examinations including cognitive tests (DemTect), life quality assessment (SF36) and depressive disorders (BDI II) as fine motor skills (HPT) and walking speed (timed 25-foot walk test) investigations.
Results:
Exploratory analyses, uncorrected for multiple comparisons, revealed region specific metabolic differences including reduced NAA concentrations in the RTL, as well as an increase of Cho in the LFL, LPL, ROL and LOL. Concurrently, increased tCr was observed in the LFL and LOL, and elevated mI was detected in the LPL, ROL and LOL. Choline concentration in the ROL correlated with the left HPT and the 25-foot walk test. Conversely, the myo-inositol concentration in the ROL correlated with the NEOS score. Anti-NMDAR encephalitis patients showed higher depression values and lower DemTect results.
Conclusion:
Our findings indicate alterations in metabolite concentrations following anti-NMDAR encephalitis, as well as cognitive deficits and depressive symptoms. The differences in metabolite concentrations were not confined to the limbic system, and may therefore reflex more widespread processes that persist even after the initial symptoms have subsided. Given the uncorrected statical analyses, these findings should be considered hypothesis-generating and require confirmation in larger independent cohorts.
