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Li G, Liu X, Yu T, Ren J, Wang Q. Positron emission tomography in autoimmune encephalitis: Clinical implications and future directions. Acta Neurol Scand 2022; 146:708-715. [PMID: 36259555 DOI: 10.1111/ane.13717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 10/04/2022] [Accepted: 10/08/2022] [Indexed: 11/28/2022]
Abstract
18 F-fluoro-deoxyglucose position emission tomography (18 F-FDG-PET) has been proven as a sensitive and reliable tool for diagnosis of autoimmune encephalitis (AE). More attention was paid to this kind of imaging because of the shortage of MRI, EEG, and CSF findings. FDG-PET has been assessed in a few small studies and case reports showing apparent abnormalities in cases where MRI does not. Here, we summarized the patterns (specific or not) in AE with different antibodies detected and the clinical outlook for the wide application of FDG-PET considering some limitations. Specific patterns based on antibody subtypes and clinical symptoms were critical for identifying suspicious AE, the most common of which was the anteroposterior gradient in anti- N -methyl- d -aspartate receptor (NMDAR) encephalitis and the medial temporal lobe hypermetabolism in limbic encephalitis. And the dynamic changes of metabolic presentations in different phases provided us the potential to inspect the evolution of AE and predict the functional outcomes. Except for the visual assessment, quantitative analysis was recently reported in some voxel-based studies of regions of interest, which suggested some clues of the future evaluation of metabolic abnormalities. Large prospective studies need to be conducted controlling the time from symptom onset to examination with the same standard of FDG-PET scanning.
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Affiliation(s)
- Gongfei Li
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Xiao Liu
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Tingting Yu
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Jiechuan Ren
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Qun Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China.,Beijing Institute for Brain Disorders, Collaborative Innovation Center for Brain Disorders, Capital Medical University, Beijing, China
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Eisermann M, Fillon L, Saitovitch A, Boisgontier J, Vinçon-Leite A, Dangouloff-Ros V, Blauwblomme T, Bourgeois M, Dangles MT, Coste-Zeitoun D, Vignolo-Diard P, Aubart M, Kossorotoff M, Hully M, Losito E, Chemaly N, Zilbovicius M, Desguerre I, Nabbout R, Boddaert N, Kaminska A. Periodic electroencephalographic discharges and epileptic spasms involve cortico-striatal-thalamic loops on Arterial Spin Labeling Magnetic Resonance Imaging. Brain Commun 2022; 4:fcac250. [PMID: 36324869 PMCID: PMC9598541 DOI: 10.1093/braincomms/fcac250] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Revised: 06/15/2022] [Accepted: 10/05/2022] [Indexed: 11/07/2022] Open
Abstract
Periodic discharges are a rare peculiar electroencephalogram pattern, occasionally associated with motor or other clinical manifestations, usually observed in critically ill patients. Their underlying pathophysiology remains poorly understood. Epileptic spasms in clusters and periodic discharges with motor manifestations share similar electroencephalogram pattern and some aetiologies of unfavourable prognosis such as subacute sclerosing panencephalitis or herpes encephalitis. Arterial spin labelling magnetic resonance imaging identifies localizing ictal and inter-ictal changes in neurovascular coupling, therefore assumed able to reveal concerned cerebral structures. Here, we retrospectively analysed ictal and inter-ictal arterial spin labelling magnetic resonance imaging in patients aged 6 months to 15 years (median 3 years 4 months) with periodic discharges including epileptic spasms, and compared these findings with those of patients with drug-resistant focal epilepsy who never presented periodic discharges nor epileptic spasms as well as to those of age-matched healthy controls. Ictal electroencephalogram was recorded either simultaneously with arterial spin labelling magnetic resonance imaging or during the close time lapse of patients' periodic discharges, whereas inter-ictal examinations were performed during the patients' active epilepsy but without seizures during the arterial spin labelling magnetic resonance imaging. Ictal arterial spin labelling magnetic resonance imaging was acquired in five patients with periodic discharges [subacute sclerosing panencephalitis (1), stroke-like events (3), West syndrome with cortical malformation (1), two of them also had inter-ictal arterial spin labelling magnetic resonance imaging]. Inter-ictal group included patients with drug-resistant epileptic spasms of various aetiologies (14) and structural drug-resistant focal epilepsy (8). Cortex, striatum and thalamus were segmented and divided in six functional subregions: prefrontal, motor (rostral, caudal), parietal, occipital and temporal. Rest cerebral blood flow values, absolute and relative to whole brain, were compared with those of age-matched controls for each subregion. Main findings were diffuse striatal as well as cortical motor cerebral blood flow increase during ictal examinations in generalized periodic discharges with motor manifestations (subacute sclerosing panencephalitis) and focal cerebral blood flow increase in corresponding cortical-striatal-thalamic subdivisions in lateralized periodic discharges with or without motor manifestations (stroke-like events and asymmetrical epileptic spasms) with straight topographical correlation with the electroencephalogram focus. For inter-ictal examinations, patients with epileptic spasms disclosed cerebral blood flow changes in corresponding cortical-striatal-thalamic subdivisions (absolute-cerebral blood flow decrease and relative-cerebral blood flow increase), more frequently when compared with the group of drug-resistant focal epilepsies, and not related to Vigabatrin treatment. Our results suggest that corresponding cortical-striatal-thalamic circuits are involved in periodic discharges with and without motor manifestations, including epileptic spasms, opening new insights in their pathophysiology and new therapeutical perspectives. Based on these findings, we propose a model for the generation of periodic discharges and of epileptic spasms combining existing pathophysiological models of cortical-striatal-thalamic network dynamics.
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Affiliation(s)
- Monika Eisermann
- Correspondence to: Monika Eisermann Clinical Neurophysiology, Hôpital Necker Enfants Malades AP-HP, Paris Université, 149 rue de Sèvres75015 Paris, France E-mail:
| | | | - Ana Saitovitch
- Pediatric Radiology Department, AP-HP, Hôpital Necker Enfants Malades, Université de Paris, F-75015, Paris, France
- Université de Paris, Institut Imagine INSERM U1163, F-75015, France
- INSERM U1299 Trajectoires développementales & psychiatrie, Paris, France
| | - Jennifer Boisgontier
- Pediatric Radiology Department, AP-HP, Hôpital Necker Enfants Malades, Université de Paris, F-75015, Paris, France
- Université de Paris, Institut Imagine INSERM U1163, F-75015, France
- INSERM U1299 Trajectoires développementales & psychiatrie, Paris, France
| | - Alice Vinçon-Leite
- Pediatric Radiology Department, AP-HP, Hôpital Necker Enfants Malades, Université de Paris, F-75015, Paris, France
- Université de Paris, Institut Imagine INSERM U1163, F-75015, France
- INSERM U1299 Trajectoires développementales & psychiatrie, Paris, France
| | - Volodia Dangouloff-Ros
- Pediatric Radiology Department, AP-HP, Hôpital Necker Enfants Malades, Université de Paris, F-75015, Paris, France
- Université de Paris, Institut Imagine INSERM U1163, F-75015, France
- INSERM U1299 Trajectoires développementales & psychiatrie, Paris, France
| | - Thomas Blauwblomme
- Pediatric Neurosurgery, Hôpital Necker, APHP, Paris France, Université de Paris, Paris, France, INSERM U1163, IHU Imagine, Paris, France
| | - Marie Bourgeois
- Pediatric Neurosurgery, Hôpital Necker, APHP, Paris France, Université de Paris, Paris, France, INSERM U1163, IHU Imagine, Paris, France
| | - Marie-Thérèse Dangles
- Clinical Neurophysiology, Hôpital Necker Enfants Malades, AP-HP, Paris Université, Paris, France
| | - Delphine Coste-Zeitoun
- Clinical Neurophysiology, Hôpital Necker Enfants Malades, AP-HP, Paris Université, Paris, France
| | - Patricia Vignolo-Diard
- Clinical Neurophysiology, Hôpital Necker Enfants Malades, AP-HP, Paris Université, Paris, France
| | - Mélodie Aubart
- Pediatric Neurology Department, Hôpital Necker Enfants Malades, AP-HP, INSERM U1163, Paris Université, Institut Imagine, Paris, France
| | - Manoelle Kossorotoff
- Pediatric Neurology Department, Necker Enfants Malades Hospital, AP-HP, Paris Université, Paris, France
| | - Marie Hully
- Pediatric Neurology Department, Necker Enfants Malades Hospital, AP-HP, Paris Université, Paris, France
| | - Emma Losito
- Clinical Neurophysiology, Hôpital Necker Enfants Malades, AP-HP, Paris Université, Paris, France
| | - Nicole Chemaly
- Reference Center for Rare Epilepsies, Department of Pediatric Neurology, Member of EPICARE Network, Institute Imagine INSERM 1163, Université de Paris, Paris, France
| | - Monica Zilbovicius
- Pediatric Radiology Department, AP-HP, Hôpital Necker Enfants Malades, Université de Paris, F-75015, Paris, France
- Université de Paris, Institut Imagine INSERM U1163, F-75015, France
- INSERM U1299 Trajectoires développementales & psychiatrie, Paris, France
| | - Isabelle Desguerre
- Pediatric Neurology Department, Hôpital Necker Enfants Malades, AP-HP, INSERM U1163, Paris Université, Institut Imagine, Paris, France
| | - Rima Nabbout
- Reference Center for Rare Epilepsies, Department of Pediatric Neurology, Member of EPICARE Network, Institute Imagine INSERM 1163, Université de Paris, Paris, France
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Zhao X, Zhao S, Chen Y, Zhang Z, Li X, Liu X, Lv R, Wang Q, Ai L. Subcortical Hypermetabolism Associated With Cortical Hypometabolism Is a Common Metabolic Pattern in Patients With Anti-Leucine-Rich Glioma-Inactivated 1 Antibody Encephalitis. Front Immunol 2021; 12:672846. [PMID: 34616389 PMCID: PMC8488294 DOI: 10.3389/fimmu.2021.672846] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 09/06/2021] [Indexed: 12/23/2022] Open
Abstract
Purpose Brain 18F-fluorodeoxyglucose positron emission tomography (FDG PET) is a sensitive technique for assisting in the diagnosis of patients with anti-leucine-rich glioma-inactivated 1 (LGI1) antibody encephalitis. However, the common pattern of this disorder assessed by FDG PET remains unknown. The present study aimed to explore the glucose metabolic patterns of this disorder based on PET voxel analysis. Methods This retrospective study enrolled 25 patients with anti-LGI1 encephalitis, who were admitted in Beijing Tiantan Hospital between September 2014 and July 2019. The glucose metabolic pattern was compared between the included patients and 44 age- and gender-matched healthy controls using Statistical Parametric Mapping. Then, the correlation between the metabolic pattern and scaled activities of daily living (ADLs) of the patients was assessed. Results The median time from symptom onset to PET scans was 9 w (range:2-53w). The groupwise analysis revealed that patients with anti-LGI1 encephalitis had left hippocampal hypermetabolism and hypometabolism in almost all neocortical regions. The individual-level results showed most patients presented a decreased metabolism in neocortical regions, as well as an increase in metabolism in the hippocampus and basal ganglia. Furthermore, the metabolic gradient between hippocampus and neocortical regions was positively associated with the ADLs (frontal lobe, r=0.529, P=0.008; parietal lobe, r=0.474, P=0.019; occipital lobe, r=0.413, P=0.045; temporal lobe, r=0.490, P=0.015), respectively. In addition, the patients with facio-brachial dystonic seizures (FBDS) presented bilateral putamen hypermetabolism, when compared to patients without FBDS and healthy controls. Conclusion Subcortical hypermetabolism associated with cortical hypometabolism presented with a common metabolic pattern in patients with anti-LGI1 encephalitis in the present study. The resolution of the metabolic gradient of the hippocampal hypermetabolism and neocortical hypometabolism may bring about improved clinical neurologic disability.
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Affiliation(s)
- Xiaobin Zhao
- Department of Nuclear Medicine, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Shaokun Zhao
- State Key Laboratory of Cognitive Neuroscience and Learning & International Data Group/McGovern Institute for Brain Research, Beijing Normal University, Beijing, China.,Beijing Aging Brain Rejuvenation Initiative Centre, Beijing Normal University, Beijing, China
| | - Yaojing Chen
- State Key Laboratory of Cognitive Neuroscience and Learning & International Data Group/McGovern Institute for Brain Research, Beijing Normal University, Beijing, China.,Beijing Aging Brain Rejuvenation Initiative Centre, Beijing Normal University, Beijing, China
| | - Zhanjun Zhang
- State Key Laboratory of Cognitive Neuroscience and Learning & International Data Group/McGovern Institute for Brain Research, Beijing Normal University, Beijing, China.,Beijing Aging Brain Rejuvenation Initiative Centre, Beijing Normal University, Beijing, China
| | - Xiaotong Li
- Department of Nuclear Medicine, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xiao Liu
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Ruijuan Lv
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Qun Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Lin Ai
- Department of Nuclear Medicine, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
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