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Abstract Details

MRI Features and their Association with Outcomes in Children with Anti-NMDA Receptor Encephalitis
Autoimmune Neurology
S22 - Autoimmune Neurology: Autoimmune Encephalitis and Other Antibody-associated Syndromes (3:54 PM-4:06 PM)
003

Up to 50% of MRIs in NMDARE are reportedly abnormal. However, data is limited on range and types of abnormalities, and also how abnormal MRIs associate with outcomes in pNMDARE.

To correlate MRI brain lesions with clinical outcomes in pediatric anti-NMDA receptor encephalitis (pNMDARE).

This was a multi-center retrospective cohort study with ten institutions. NMDARE was defined as positive CSF NMDA-receptor antibody and at least one neuropsychiatric symptom. Patients with prior HSV encephalitis were excluded. Outcomes were assessed by the modified Rankin Score (mRS) at 1 year with good (mRS ≤ 2) and poor (mRS ≥ 3) outcomes and also for full recovery (mRS=0) versus incomplete recovery (mRS>0). Statistical analyses were performed using SAS 16.0 (Cary, NC). 

A total of 169 patients with pNMDARE were included, with one-year mRS available in 134/169 (79%). Abnormal MRIs were found in 59/169 (35%), and were associated with an increased likelihood of intubation and ICU admission (chi-square, p = 0.038 and p=0.045, respectively). The most common T2 FLAIR lesion locations were frontal (29/59, 49%), temporal (28/59, 47%), parietal (19/59, 32%), and hippocampal lesions (11/59, 19%). MRI enhancement was seen in 34/165 (21%) and MRI brain atrophy was seen in 4% (6/168). MRI features that predicted incomplete recovery at one year (mRS > 0) was the presence of T2 frontal lobe lesions (chi-square, p = 0.0427). G-tube placement and intubation also predicted incomplete recovery. On multivariable logistic regression analysis using backward selection, one-year mRS was associated with: intubation (OR 0.232, 95%CI 0.103-0.526) and T2 frontal lesions on MRI (OR 0.373, 95% 0.148-0.938).

Abnormal frontal lesions on MRI along with intubation may associate with one-year mRS in pNMDARE. MRIs may be a helpful tool for prognostication, which will be examined in future studies.

Authors/Disclosures
Coral Marie Stredny, MD (Children's Hospital Boston)
PRESENTER
Dr. Stredny has stock in Proctor and Gamble. The institution of Dr. Stredny has received research support from Pediatric Epilepsy Research Foundation.
Grace Gombolay, MD (Emory University/Children'S Healthcare of Atlanta) Dr. Gombolay has received personal compensation in the range of $0-$499 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Pediatric Neurology. An immediate family member of Dr. Gombolay has received personal compensation in the range of $500-$4,999 for serving as an Expert Witness for Washington Injury Lawyers. The institution of Dr. Gombolay has received research support from CDC. The institution of Dr. Gombolay has received research support from NIH.
James Nick Brenton, MD Dr. Brenton has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for I-ACT on a Novartis sponsored project. Dr. Brenton has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Cycle Pharmaceuticals. The institution of Dr. Brenton has received research support from NIH/NINDS. Dr. Brenton has received personal compensation in the range of $500-$4,999 for serving as a Grant Reviewer with Department of Defense. Dr. Brenton has received personal compensation in the range of $500-$4,999 for serving as a Expert Interview with MDEdge. Dr. Brenton has received personal compensation in the range of $0-$499 for serving as a Grant Reviewer with NIH.
Jennifer H. Yang, MD (Rady Childrens Hospital/UCSD) Dr. Yang has received personal compensation in the range of $5,000-$9,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Sanofi. The institution of Dr. Yang has received research support from Pediatric Epilepsy Research Foundation. The institution of Dr. Yang has received research support from UCB.
Ryan Kammeyer, MD (Childrens Hospital Colorado) The institution of Dr. Kammeyer has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Sanofi-Genzyme. Dr. Kammeyer has received personal compensation in the range of $500-$4,999 for serving as an Expert Witness for Ogborn-Mihm Trial Lawyers. The institution of Dr. Kammeyer has received research support from Rocky Mountain Multiple Sclerosis Center.
Catherine E. Otten, MD The institution of Dr. Otten has received research support from CDC.
NgocHanh H. Vu, MD (Vanderbilt University, Child Neurology) Dr. Vu has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Syneos Health.
Jonathan Santoro, MD (Department of Neurology, Children's Hospital Los Angeles) Dr. Santoro has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for UCB. Dr. Santoro has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Cycle Pharma.
Karla Robles Lopez, MD (UNIVERSITY OF TEXAS AT AUSTIN/DMS) Dr. ROBLES LOPEZ has nothing to disclose.
Andrew Christiana, MD (NYU) Dr. Christiana has nothing to disclose.
Claude Steriade, MD (NYU) The institution of Dr. Steriade has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for The Epilepsy Study Consortium. Dr. Steriade has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Dynamed. Dr. Steriade has received personal compensation in the range of $5,000-$9,999 for serving as an Expert Witness for DOJ. The institution of Dr. Steriade has received research support from NIH. Dr. Steriade has received personal compensation in the range of $500-$4,999 for serving as a Consultant with Epitel. Dr. Steriade has received personal compensation in the range of $500-$4,999 for serving as a Consultant with Jazz Pharmaceuticals.
Morgan E. Morris, Other (Emory University) Miss Morris has nothing to disclose.
Mark Gorman, MD The institution of Dr. Gorman has received research support from Pfizer. The institution of Dr. Gorman has received research support from Roche / Genetech .
Manikum Moodley, MD Dr. Moodley has nothing to disclose.
Duriel Isaiah Hardy, MD (Dell Children's Specialty Pavillian) Dr. Hardy has nothing to disclose.
Alexandra Behar Kornbluh, MD (Children's National Hospital) Dr. Kornbluh has nothing to disclose.
Ilana L. Kahn, MD (Childrens National Medical Center) Dr. Kahn has nothing to disclose.
Leigh Nicole Sepeta, PhD (Children'S National Health System) Dr. Sepeta has received personal compensation in the range of $500,000-$999,999 for serving as a Grant PI with Nih. Dr. Sepeta has a non-compensated relationship as a Special volunteer with Nih that is relevant to AAN interests or activities.
Anusha Yeshokumar, MD (Icahn School of Medicine at Mount Sinai) Dr. Yeshokumar has nothing to disclose.