Brain 18F-FDG PET for the diagnosis of autoimmune encephalitis: a systematic review and a meta-analysis

Bordonné, Manon; Chawki, Mohammad.B; Doyen, Matthieu; Kas, Aurélie; Guedj, Éric; Tyvaert, Louise; Verger, Antoine

doi:10.21203/rs.3.rs-243472/v1

Cited by 5 publications

(7 citation statements)

References 27 publications

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“…A further novelty of our case is detailed information about 18 F -FDG PET and FET PET within double positive anti-NMDAR and anti-MOG patients. Published data are subsumed in the Supplemental Table . Previous studies have already reported that in NMDAR encephalitis 18 F -FDG PET can reveal both hypo-and hypermetabolism [42]. With our case, we contribute longitudinal data of four 18 F -FDG PET scans and one FET PET scan.…”

Section: Discussionmentioning

confidence: 86%

Anti-NMDA receptor encephalitis and MOG-associated demyelination – a case report with long-term follow-up and a systematic review

et al. 2022

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Background Overlap syndromes of anti-NMDA receptor encephalitis and MOG-mediated demyelination have been reported. In this case we provide a long-term longitudinal follow-up of clinical and imaging characteristics as well as of antibody dynamics. Case presentation We report a 32-year-old male patient who presented with psychosis, decreased consciousness and movement disorders and was tested positive for anti-NMDA receptor antibodies. Forty-four months after symptom onset and diagnosis of autoimmune encephalitis, he suffered from relapse. At this time, the patient developed anti-MOG and anti-Caspr2 antibodies. Treatment with plasmapheresis, steroids and rituximab eventually led to substantial clinical and radiological improvement. Anti-Caspr2 antibodies persisted, anti-NMDA receptor antibodies decreased, while anti-MOG antibodies turned negative again. Conclusion We provide long-term longitudinal follow-up of a patient with anti-NMDA receptor encephalitis who developed triple antibody positivity at the time of relapse. Antibody dynamics were associated with clinical disease course.

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Section: Discussionmentioning

confidence: 86%

Anti-NMDA receptor encephalitis and MOG-associated demyelination – a case report with long-term follow-up and a systematic review

et al. 2022

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“…Firstly, FDG‐PET changes reflected functional abnormality developing earlier than the structural changes on MRI, which contributed a lot to early diagnosis and subsequent treatment. Secondly, some autoimmune encephalitis revealed specific metabolic changes because of the distinction of antigen distribution 2,46 . Thirdly, different antibodies may cause metabolic abnormalities in the same regions of brain, with the manifestations of corresponding anatomical syndromes, such as limbic encephalitis, striatal encephalitis, brainstem encephalitis, and cerebellar degeneration 47 .…”

Section: Discussionmentioning

confidence: 99%

“…Secondly, some autoimmune encephalitis revealed specific metabolic changes because of the distinction of antigen distribution. 2,46 Thirdly, different antibodies may cause metabolic abnormalities in the same regions of brain, with the manifestations of corresponding anatomical syndromes, such as limbic encephalitis, striatal encephalitis, brainstem encephalitis, and cerebellar degeneration. 47 Fourthly, FDG-PET tend to show hypermetabolism in acute phase but hypometabolism or normal FDG uptake in chronic phase, which help us to understand the evolution of AE and detect the pathophysiological mechanism.…”

Section: Discussionmentioning

confidence: 99%

Positron emission tomography in autoimmune encephalitis: Clinical implications and future directions

Liu

et al. 2022

Acta Neuro Scandinavica

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Autoimmune encephalitis is an immune-mediated inflammatory disease of the central nervous system caused by abnormal immune response against surface or intracellular antigens. 1 In addition to the previously discovered classical paraneoplastic encephalitisassociated antibodies, a variety of autoimmune encephalitis-related antibodies have been reported in recent years, including antibodies targeting N-methyld-aspartate receptor (NMDAR), alpha-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid receptor (AMPAR), leucine-rich glioma inactivated 1 (LGI1), contactin-associated proteinlike 2 (CASPR2), gamma-aminobutyric acid receptor (GABAR) A/B, dipeptidyl-peptidase-like protein-6 (DPPX), glycine receptor (GlyR), glutamic acid decarboxylase 65 (GAD65), dipeptidyl-peptidase-like protein-6 (DPPX), IgLON5 et al. 2 The clinical manifestations, severity, and prognosis with specific antibodies are different, but in general, early detection and early treatment are the principles to handle this disease. However, it has to be admitted that there are still difficulties in the early diagnosis of autoimmune encephalitis, although we have made improvements and revision in the diagnostic criteria based on the clinical criteria defined by Graus et al. 3 in 2016 to avoid excessive reliance on the detection of autoimmune antibodies from serum or cerebrospinal fluid (CSF). The problems focus on the heterogeneity of clinical manifestations, low positive rate of imaging evidence, and lack of specificity of EEG. For example, autoimmune encephalitis may involve

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“…(1) The crosssectional and retrospective nature of current study could not determine other potential risk factors associated with NSAbs in the elderly with new-onset and symptomatic seizures or epilepsy of unknown etiology, such as 18 F-fluorodeoxy-glucose positron emission tomography ( 18 F-FDG-PET). Prior studies have shown that 18 F-FDG-PET may play a key role in the diagnosis of autoimmune encephalitis, 35 but these imaging data were not available for all included patients in this retrospective study. Additionally, we did not cover the entire repertoire testing for NSAbs, such as novel DPPX, IgLON5, which may lead to underestimation of positive NSAbs and our nomogram may be corrected in the future with recognition of novel NSAbs.…”

Section: Discussionmentioning

confidence: 99%

Factors predicting neuronal surface antibodies in the elderly with new‐onset and unknown seizures

Liu

et al. 2022

Ann Clin Transl Neurol

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Objective To investigate risk factors of neuronal surface antibodies (NSAbs) and develop a nomogram that could identify patients at the odds of NSAbs among the elderly (aged 60 years or older) with new‐onset seizures of unknown etiology. Methods Clinical data for aged ≥60 years diagnosed with new‐onset seizures of unknown etiology were retrospectively reviewed. A nomogram based on multivariable logistic regression was constructed. Model performance of nomogram was evaluated using area under the curve (AUC), calibration curve, decision curve analysis (DCA), and clinical impact curve (CIC). Meanwhile, it was internally validated by bootstrap validation in current cohort. Results Of 147 patients included in final analysis, 68 (46.3%) had NSAbs‐mediated encephalitis. Six factors were identified: duration of seizures less than 3 months (OR:14.259; 95% CI: 4.480–45.386), focal‐onset seizures (OR:12.457; 95% CI: 2.710–57.261), psychiatric deficits (OR:10.063; 95% CI: 3.231–31.343), sleep disorders (OR:3.091; 95% CI: 1.011–9.454), hyponatremia (OR:6.252; 95% CI: 1.445–27.043), and medial temporal lobe (MTL) lesions on MRI (OR:4.102; 95% CI: 1.382–12.169). The nomogram had a good discrimination with an AUC of 0.916 and with a corrected AUC of 0.881 after the bootstrapping validation, our model also exhibited a better predictive performance than scoring systems commonly used clinically. Additionally, the calibration curve showed that predicted NSAbs‐positive rates of nomogram were closely aligned with actual observed results. Moreover, the nomogram achieved well on clinical utility by using the DCA and CIC. Interpretation Our nomogram may provide a convenient and useful tool for identifying the elderly with new‐onset seizures of unknown etiology who are at risk of NSAbs‐mediated encephalitis, which would allow these patients receive earlier immunotherapy.

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Brain 18F-FDG PET for the diagnosis of autoimmune encephalitis: a systematic review and a meta-analysis

Cited by 5 publications

References 27 publications

Anti-NMDA receptor encephalitis and MOG-associated demyelination – a case report with long-term follow-up and a systematic review

Anti-NMDA receptor encephalitis and MOG-associated demyelination – a case report with long-term follow-up and a systematic review

Positron emission tomography in autoimmune encephalitis: Clinical implications and future directions

Factors predicting neuronal surface antibodies in the elderly with new‐onset and unknown seizures

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