Quantitative EEG as a Prognostic Tool in Suspected Anti-N-Methyl-d-Aspartate Receptor Antibody Encephalitis

Blackman, Graham; Kumar, Kieron; Hanrahan, John; Dalrymple, Anthony; Mullatti, Nandini; Moran, Nick; Valentı́n, Antonio; Gibson, Lucy; Pollak, Thomas; David, Anthony S.

doi:10.1097/wnp.0000000000000877

Cited by 7 publications

(5 citation statements)

References 25 publications

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“…In anti-NMDAR encephalitis, a significant increase in δ relative band power and a significant decrease in β relative band power and β absolute band power in the posterior region have been reported ( 33 ). A higher peak frequency within the delta range was associated with poorer clinical outcomes in anti-NMDAR encephalitis ( 34 ). It is widely known that almost all recorded neurons spontaneously oscillate slowly in the delta range when they are anatomically or functionally disconnected from other cortical regions ( 35 ).…”

Section: Discussionmentioning

confidence: 99%

The micro and macro interactions in acute autoimmune encephalitis: a study of resting-state EEG

Liu

Lü

et al. 2023

Front. Neurol.

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ObjectiveEarly recognition of autoimmune encephalitis (AIE) is often difficult and time-consuming. Understanding how the micro-level (antibodies) and macro-level (EEG) couple with each other may help rapidly diagnose and appropriately treat AIE. However, limited studies focused on brain oscillations involving micro- and macro-interactions in AIE from a neuro-electrophysiological perspective. Here, we investigated brain network oscillations in AIE using Graph theoretical analysis of resting state EEG.MethodsAIE Patients (n = 67) were enrolled from June 2018 to June 2022. Each participant underwent a ca.2-hour 19-channel EEG examination. Five 10-second resting state EEG epochs with eyes closed were extracted for each participant. The functional networks based on the channels and Graph theory analysis were carried out.ResultsCompared with the HC group, significantly decreased FC across whole brain regions at alpha and beta bands were found in AIE patients. In addition, the local efficiency and clustering coefficient of the delta band was higher in AIE patients than in the HC group (P < 0.05). AIE patients had a smaller world index (P < 0.05) and higher shortest path length (P < 0.001) in the alpha band than those of the control group. Also, the AIE patients' global efficiency, local efficiency, and clustering coefficients decreased in the alpha band (P < 0.001). Different types of antibodies (antibodies against ion channels, antibodies against synaptic excitatory receptors, antibodies against synaptic inhibitory receptors, and multiple antibodies positive) showed distinct graph parameters. Moreover, the graph parameters differed in the subgroups by intracranial pressure. Correlation analysis revealed that magnetic resonance imaging abnormalities were related to global efficiency, local efficiency, and clustering coefficients in the theta, alpha, and beta bands, but negatively related to the shortest path length.ConclusionThese findings add to our understanding of how brain FC and graph parameters change and how the micro- (antibodies) scales interact with the macro- (scalp EEG) scale in acute AIE. The clinical traits and subtypes of AIE may be suggested by graph properties. Further longitudinal cohort studies are needed to explore the associations between these graph parameters and recovery status, and their possible applications in AIE rehabilitation.

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Section: Discussionmentioning

confidence: 99%

The micro and macro interactions in acute autoimmune encephalitis: a study of resting-state EEG

Liu

Lü

et al. 2023

Front. Neurol.

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“…Concerning the anti-NMDARE, the enhanced delta power in the NMDA-receptor antibodies positive model across a wide range of time-constant fluctuations has also been reported ( 36 ), while the weaker delta power thereby indicates a recovery in patients with encephalitis ( 37 ). Additionally, a higher delta peak is found to be associated with poorer clinical outcomes and thus indicates anti-NMDAR-mediated synaptic dysfunction ( 38 ). Considering theta activity is regarded as a credible EEG indicator of normal brain functions including attention and memory ( 39 ), and delta activity is involved in the integration of cerebral activity with homeostatic processes ( 40 ), the distortions of both rhythmic powers may thereby implicate the persistent and residual pathological states such as anhedonia or reward deficiency ( 40 ) in anti-NMDARE patients even after clinical recovery.…”

Section: Discussionmentioning

confidence: 99%

Brain rhythmic abnormalities in convalescent patients with anti-NMDA receptor encephalitis: a resting-state EEG study

Jiang

et al. 2023

Front. Neurol.

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ObjectiveAnti-N-methyl-D-aspartate receptor encephalitis (anti-NMDARE) is autoimmune encephalitis with a characteristic neuropsychiatric syndrome and persistent cognition deficits even after clinical remission. The objective of this study was to uncover the potential noninvasive and quantified biomarkers related to residual brain distortions in convalescent anti-NMDARE patients.MethodsBased on resting-state electroencephalograms (EEG), both power spectral density (PSD) and brain network analysis were performed to disclose the persistent distortions of brain rhythms in these patients. Potential biomarkers were then established to distinguish convalescent patients from healthy controls.ResultsOppositely configured spatial patterns in PSD and network architecture within specific rhythms were identified, as the hyperactivated PSD spanning the middle and posterior regions obstructs the inter-regional information interactions in patients and thereby leads to attenuated frontoparietal and frontotemporal connectivity. Additionally, the EEG indexes within delta and theta rhythms were further clarified to be objective biomarkers that facilitated the noninvasive recognition of convalescent anti-NMDARE patients from healthy populations.ConclusionCurrent findings contributed to understanding the persistent and residual pathological states in convalescent anti-NMDARE patients, as well as informing clinical decisions of prognosis evaluation.

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“…Its performance in Chinese patients was subsequently evaluated in a multicenter, prospective study by Peng et al It showed good discrimination and calibration power with an AUC of 0.86 and a Pearson correlation coefficient of 0.53 (6). On the contrary, results from another study showed that the NEOS score was not associated with one-year outcomes of patients (13). However, this study only included a small sample size (20 patients) which may lead to substantial statistical bias.…”

Section: Discussionmentioning

confidence: 99%

External Assessment of the Anti-N-Methyl-D-Aspartate Receptor Encephalitis One-Year Functional Status Score in Chinese Pediatric Patients

Luo

Li²,

Zheng³

et al. 2022

Front. Immunol.

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Objectiveto assess the performance of the Anti-N-Methyl-D-Aspartate Receptor encephalitis (NMDAR) One-Year Functional Status (NEOS) score in predicting one-year functional outcome in Chinese children with anti-NMDAR encephalitis.Methodschildren with anti-NMDAR encephalitis at the Children’s Hospital of Chongqing Medical University were retrospectively enrolled from January 2014 to December 2020. Patients were categorized into two groups based on the modified Rankin Scale (mRS) at one-year follow-up. Discrimination of the NEOS score was assessed by the area under curve (AUC) of the receiver operating characteristic curve. Calibration of the NEOS score was assessed by comparing predicted probabilities with observed probabilities using a calibration curve and the Hosmer-Lemeshow test. The clinical practicability of the NEOS score was evaluated by performing a decision curve analysis.Resultsone hundred seventy-five children (101 females and 74 males) with anti-NMDAR encephalitis and a median age of 7.7 years were enrolled. Of those, 149 (85.1%) had a good outcome at 1 year (mRS ≤ 2), and the remaining 26 (14.9%) had a poor outcome (mRS > 2). Patients with a higher NEOS score had a significantly higher mRS at one-year follow-up [Spearman r = 0.3878, 95% confidence interval (CI): 0.2500-0.5103, P < 0.001]. The AUC of the NEOS score was 0.870 (95% CI: 0.801-0.938, P < 0.001). The observed probability and predicted probability showed moderate consistency in the calibration curve and the Hosmer-Lemeshow test (P = 0.912). The decision curve analysis showed that using the NEOS score to predict one-year outcomes could provide additional net benefit during clinical practice.Conclusionsthe NEOS score is a potentially reliable model to predict the one-year functional outcome in Chinese children with anti-NMDAR encephalitis.

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Quantitative EEG as a Prognostic Tool in Suspected Anti-N-Methyl-d-Aspartate Receptor Antibody Encephalitis

Abstract: Supplemental Digital Content is Available in the Text.

Cited by 7 publications

References 25 publications

The micro and macro interactions in acute autoimmune encephalitis: a study of resting-state EEG

The micro and macro interactions in acute autoimmune encephalitis: a study of resting-state EEG

Brain rhythmic abnormalities in convalescent patients with anti-NMDA receptor encephalitis: a resting-state EEG study

External Assessment of the Anti-N-Methyl-D-Aspartate Receptor Encephalitis One-Year Functional Status Score in Chinese Pediatric Patients

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