Fluorodeoxyglucose positron emission tomography in anti-N-methyl-D-aspartate receptor encephalitis: distinct pattern of disease
Open Access
- 7 May 2012
- journal article
- neuro inflammation
- Published by BMJ in Journal of Neurology, Neurosurgery & Psychiatry
- Vol. 83 (7), 681-686
- https://doi.org/10.1136/jnnp-2011-301969
Abstract
Background Patients with encephalitis associated with antibodies against N-methyl-D-aspartate-receptor antibody (NMDAR-ab) encephalitis frequently show psychotic symptoms, amnesia, seizures and movement disorders. While brain MRI in NMDAR-ab encephalitis is often normal, abnormalities of cerebral glucose metabolism have been demonstrated by positron emission tomography (PET) with 18F-fluorodeoxyglucose(FDG) in a few usually isolated case reports. However, a common pattern of FDG-PET abnormalities has not been reported. Methods The authors retrospectively identified six patients with NMDAR-ab encephalitis in two large German centres who underwent at least one whole-body FDG-PET for tumour screening between January 2007 and July 2010. They analysed the pattern of cerebral uptake derived from whole-body PET data for characteristic changes of glucose metabolism compared with controls, and the changes of this pattern during the course of the disease. Results Groupwise analysis revealed that patients with NMDAR-ab encephalitis showed relative frontal and temporal glucose hypermetabolism associated with occipital hypometabolism. Cross-sectional analysis of the group demonstrated that the extent of these changes is positively associated with clinical disease severity. Longitudinal analysis of two cases showed normalisation of the pattern of cerebral glucose metabolism with recovery. Conclusions A characteristic change in cerebral glucose metabolism during NMDAR-ab encephalitis is an increased frontotemporal-to-occipital gradient. This pattern correlates with disease severity. Similar changes have been observed in psychosis induced by NMDAR antagonists. Thus, this pattern might be a consequence of impaired NMDAR function.Keywords
This publication has 38 references indexed in Scilit:
- Analysis of complement and plasma cells in the brain of patients with anti-NMDAR encephalitisNeurology, 2011
- Clinical experience and laboratory investigations in patients with anti-NMDAR encephalitisThe Lancet Neurology, 2011
- Cortical Hypometabolism Demonstrated by PET in Relapsing NMDA Receptor EncephalitisPediatric Neurology, 2010
- Acute behavioural change in a young woman evolving towards cerebellar syndromeClinical Neurology and Neurosurgery, 2010
- FDG-PET hyperactivity in basal ganglia correlating with clinical course in anti-NDMA-R antibodies encephalitisJournal of Neurology, Neurosurgery & Psychiatry, 2010
- N-methyl-d-aspartate antibody encephalitis: temporal progression of clinical and paraclinical observations in a predominantly non-paraneoplastic disorder of both sexesBrain, 2010
- Cellular and Synaptic Mechanisms of Anti-NMDA Receptor EncephalitisJournal of Neuroscience, 2010
- Evidence for antibody-mediated pathogenesis in anti-NMDAR encephalitis associated with ovarian teratomaActa Neuropathologica, 2009
- Anti-NMDA receptor encephalitis in JapanNeurology, 2008
- Interobserver agreement for the assessment of handicap in stroke patients.Stroke, 1988