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J Neurol Neurosurg Psychiatry. 2018 May;89(5):518-525. doi: 10.1136/jnnp-2017-316822. Epub 2017 Nov 3.

Superficial white matter damage in anti-NMDA receptor encephalitis.

Author information

1
Department of Psychiatry, Division of Child and Adolescent Psychiatry, Stanford University School of Medicine, Stanford, California, USA.
2
Department of Neurology, Ahmanson Lovelace Brain Mapping Center, David Geffen School of Medicine at UCLA, Los Angeles, California, USA.
3
Department of Mental Health, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia.
4
Department of Clinical and Behavioral Neurology, IRCCS Santa Lucia Foundation, Rome, Italy.
5
Department of Neurology, Charité University Medicine Berlin, Berlin, Germany.
6
German Center for Neurodegenerative Diseases (DZNE), Berlin, Germany.
7
NeuroCure Clinical Research Center, Berlin, Germany.
8
Experimental and Clinical Research Center, Charité Universitätsmedizin, Berlin, Germany.
9
Experimental and Clinical Research Center, Max Delbrueck Center for Molecular Medicine, Berlin, Germany.
10
Berlin School of Mind and Brain, Humboldt-Universität zu Berlin, Berlin, Germany.

Abstract

BACKGROUND:

Clinical brain MRI is normal in the majority of patients with anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis. However, extensive deep white matter damage wasrecently identifiedin these patients using diffusion weighted imaging. Here, our aim was to study a particularly vulnerable brain compartment, the late myelinating superficial white matter.

METHODS:

Forty-six patients with anti-NMDAR encephalitis were included. Ten out of these were considered neurologically recovered (modified Rankin scale of zero), while 36 patients were non-recovered. In addition, 30 healthy controls were studied. MRI data were collected from all subjects and superficial white matter mean diffusivity derived from diffusion tensor imaging was compared between groups in whole brain, lobar and vertex-based analyses. Patients underwent comprehensive cognitive testing, and correlation analyses were performed between cognitive performance and superficial white matter integrity.

RESULTS:

Non-recovered patients showed widespread superficial white matter damage in comparison to recovered patients and healthy controls. Vertex-based analyses revealed that damage predominated in frontal and temporal lobes. In contrast, the superficial white matter was intact in recovered patients. Importantly, persistent cognitive impairments in working memory, verbal memory, visuospatial memory and attention significantly correlated with damage of the superficial white matter in patients.

CONCLUSIONS:

Anti-NMDAR encephalitis is associated with extensive superficial white matter damage in patients with incomplete recovery. The strong association with impairment in several cognitive domains highlights the clinical relevance of white matter damage in this disorder and warrants investigations of the underlying pathophysiological mechanisms.

PMID:
29101253
PMCID:
PMC5899027
[Available on 2019-05-01]
DOI:
10.1136/jnnp-2017-316822

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