MRI Features and Their Association With Outcomes in Children With Anti-NMDA Receptor Encephalitis

Grace Gombolay, From the Emory University SOM and Children's Healthcare of Atlanta (G.G., M. Morris); University of Virginia Health System (J.N.B.); University of California San Diego and Rady Children's Hospital San Diego (J.H.Y.); Boston Children's Hospital and Harvard Medical School (C.M.S., M.G.); University of Colorado SOM and Children's Hospital Colorado (R.K.); Seattle Children's/University of Washington (C.E.O.); Vanderbilt University Medical Center (N.V.); Children's Hospital Los Angeles and Keck School of Medicine (J.D.S.), University of Southern California; University of Texas at Austin and Dell Medical School (K.R.-L., M. Moodley, D.H.); New York University SOM (A.C., C.S.); Children's National Hospital and George Washington University Medical School (A.B.K., I.K., L.N.S.); Mount Sinai University and Bristol Myers Squibb (A.Y.). grace.yoonheekim.gombolay@emory.edu.
J Nicholas Brenton, From the Emory University SOM and Children's Healthcare of Atlanta (G.G., M. Morris); University of Virginia Health System (J.N.B.); University of California San Diego and Rady Children's Hospital San Diego (J.H.Y.); Boston Children's Hospital and Harvard Medical School (C.M.S., M.G.); University of Colorado SOM and Children's Hospital Colorado (R.K.); Seattle Children's/University of Washington (C.E.O.); Vanderbilt University Medical Center (N.V.); Children's Hospital Los Angeles and Keck School of Medicine (J.D.S.), University of Southern California; University of Texas at Austin and Dell Medical School (K.R.-L., M. Moodley, D.H.); New York University SOM (A.C., C.S.); Children's National Hospital and George Washington University Medical School (A.B.K., I.K., L.N.S.); Mount Sinai University and Bristol Myers Squibb (A.Y.).
Jennifer H. Yang, From the Emory University SOM and Children's Healthcare of Atlanta (G.G., M. Morris); University of Virginia Health System (J.N.B.); University of California San Diego and Rady Children's Hospital San Diego (J.H.Y.); Boston Children's Hospital and Harvard Medical School (C.M.S., M.G.); University of Colorado SOM and Children's Hospital Colorado (R.K.); Seattle Children's/University of Washington (C.E.O.); Vanderbilt University Medical Center (N.V.); Children's Hospital Los Angeles and Keck School of Medicine (J.D.S.), University of Southern California; University of Texas at Austin and Dell Medical School (K.R.-L., M. Moodley, D.H.); New York University SOM (A.C., C.S.); Children's National Hospital and George Washington University Medical School (A.B.K., I.K., L.N.S.); Mount Sinai University and Bristol Myers Squibb (A.Y.).
Coral M. Stredny, From the Emory University SOM and Children's Healthcare of Atlanta (G.G., M. Morris); University of Virginia Health System (J.N.B.); University of California San Diego and Rady Children's Hospital San Diego (J.H.Y.); Boston Children's Hospital and Harvard Medical School (C.M.S., M.G.); University of Colorado SOM and Children's Hospital Colorado (R.K.); Seattle Children's/University of Washington (C.E.O.); Vanderbilt University Medical Center (N.V.); Children's Hospital Los Angeles and Keck School of Medicine (J.D.S.), University of Southern California; University of Texas at Austin and Dell Medical School (K.R.-L., M. Moodley, D.H.); New York University SOM (A.C., C.S.); Children's National Hospital and George Washington University Medical School (A.B.K., I.K., L.N.S.); Mount Sinai University and Bristol Myers Squibb (A.Y.).
Ryan Kammeyer, From the Emory University SOM and Children's Healthcare of Atlanta (G.G., M. Morris); University of Virginia Health System (J.N.B.); University of California San Diego and Rady Children's Hospital San Diego (J.H.Y.); Boston Children's Hospital and Harvard Medical School (C.M.S., M.G.); University of Colorado SOM and Children's Hospital Colorado (R.K.); Seattle Children's/University of Washington (C.E.O.); Vanderbilt University Medical Center (N.V.); Children's Hospital Los Angeles and Keck School of Medicine (J.D.S.), University of Southern California; University of Texas at Austin and Dell Medical School (K.R.-L., M. Moodley, D.H.); New York University SOM (A.C., C.S.); Children's National Hospital and George Washington University Medical School (A.B.K., I.K., L.N.S.); Mount Sinai University and Bristol Myers Squibb (A.Y.).
Catherine E. Otten, From the Emory University SOM and Children's Healthcare of Atlanta (G.G., M. Morris); University of Virginia Health System (J.N.B.); University of California San Diego and Rady Children's Hospital San Diego (J.H.Y.); Boston Children's Hospital and Harvard Medical School (C.M.S., M.G.); University of Colorado SOM and Children's Hospital Colorado (R.K.); Seattle Children's/University of Washington (C.E.O.); Vanderbilt University Medical Center (N.V.); Children's Hospital Los Angeles and Keck School of Medicine (J.D.S.), University of Southern California; University of Texas at Austin and Dell Medical School (K.R.-L., M. Moodley, D.H.); New York University SOM (A.C., C.S.); Children's National Hospital and George Washington University Medical School (A.B.K., I.K., L.N.S.); Mount Sinai University and Bristol Myers Squibb (A.Y.).
NgocHanh Vu, From the Emory University SOM and Children's Healthcare of Atlanta (G.G., M. Morris); University of Virginia Health System (J.N.B.); University of California San Diego and Rady Children's Hospital San Diego (J.H.Y.); Boston Children's Hospital and Harvard Medical School (C.M.S., M.G.); University of Colorado SOM and Children's Hospital Colorado (R.K.); Seattle Children's/University of Washington (C.E.O.); Vanderbilt University Medical Center (N.V.); Children's Hospital Los Angeles and Keck School of Medicine (J.D.S.), University of Southern California; University of Texas at Austin and Dell Medical School (K.R.-L., M. Moodley, D.H.); New York University SOM (A.C., C.S.); Children's National Hospital and George Washington University Medical School (A.B.K., I.K., L.N.S.); Mount Sinai University and Bristol Myers Squibb (A.Y.).
Jonathan D. Santoro, From the Emory University SOM and Children's Healthcare of Atlanta (G.G., M. Morris); University of Virginia Health System (J.N.B.); University of California San Diego and Rady Children's Hospital San Diego (J.H.Y.); Boston Children's Hospital and Harvard Medical School (C.M.S., M.G.); University of Colorado SOM and Children's Hospital Colorado (R.K.); Seattle Children's/University of Washington (C.E.O.); Vanderbilt University Medical Center (N.V.); Children's Hospital Los Angeles and Keck School of Medicine (J.D.S.), University of Southern California; University of Texas at Austin and Dell Medical School (K.R.-L., M. Moodley, D.H.); New York University SOM (A.C., C.S.); Children's National Hospital and George Washington University Medical School (A.B.K., I.K., L.N.S.); Mount Sinai University and Bristol Myers Squibb (A.Y.).
Karla Robles-Lopez, From the Emory University SOM and Children's Healthcare of Atlanta (G.G., M. Morris); University of Virginia Health System (J.N.B.); University of California San Diego and Rady Children's Hospital San Diego (J.H.Y.); Boston Children's Hospital and Harvard Medical School (C.M.S., M.G.); University of Colorado SOM and Children's Hospital Colorado (R.K.); Seattle Children's/University of Washington (C.E.O.); Vanderbilt University Medical Center (N.V.); Children's Hospital Los Angeles and Keck School of Medicine (J.D.S.), University of Southern California; University of Texas at Austin and Dell Medical School (K.R.-L., M. Moodley, D.H.); New York University SOM (A.C., C.S.); Children's National Hospital and George Washington University Medical School (A.B.K., I.K., L.N.S.); Mount Sinai University and Bristol Myers Squibb (A.Y.).
Andrew Christiana, From the Emory University SOM and Children's Healthcare of Atlanta (G.G., M. Morris); University of Virginia Health System (J.N.B.); University of California San Diego and Rady Children's Hospital San Diego (J.H.Y.); Boston Children's Hospital and Harvard Medical School (C.M.S., M.G.); University of Colorado SOM and Children's Hospital Colorado (R.K.); Seattle Children's/University of Washington (C.E.O.); Vanderbilt University Medical Center (N.V.); Children's Hospital Los Angeles and Keck School of Medicine (J.D.S.), University of Southern California; University of Texas at Austin and Dell Medical School (K.R.-L., M. Moodley, D.H.); New York University SOM (A.C., C.S.); Children's National Hospital and George Washington University Medical School (A.B.K., I.K., L.N.S.); Mount Sinai University and Bristol Myers Squibb (A.Y.).
Claude Steriade, From the Emory University SOM and Children's Healthcare of Atlanta (G.G., M. Morris); University of Virginia Health System (J.N.B.); University of California San Diego and Rady Children's Hospital San Diego (J.H.Y.); Boston Children's Hospital and Harvard Medical School (C.M.S., M.G.); University of Colorado SOM and Children's Hospital Colorado (R.K.); Seattle Children's/University of Washington (C.E.O.); Vanderbilt University Medical Center (N.V.); Children's Hospital Los Angeles and Keck School of Medicine (J.D.S.), University of Southern California; University of Texas at Austin and Dell Medical School (K.R.-L., M. Moodley, D.H.); New York University SOM (A.C., C.S.); Children's National Hospital and George Washington University Medical School (A.B.K., I.K., L.N.S.); Mount Sinai University and Bristol Myers Squibb (A.Y.).
Morgan Morris, From the Emory University SOM and Children's Healthcare of Atlanta (G.G., M. Morris); University of Virginia Health System (J.N.B.); University of California San Diego and Rady Children's Hospital San Diego (J.H.Y.); Boston Children's Hospital and Harvard Medical School (C.M.S., M.G.); University of Colorado SOM and Children's Hospital Colorado (R.K.); Seattle Children's/University of Washington (C.E.O.); Vanderbilt University Medical Center (N.V.); Children's Hospital Los Angeles and Keck School of Medicine (J.D.S.), University of Southern California; University of Texas at Austin and Dell Medical School (K.R.-L., M. Moodley, D.H.); New York University SOM (A.C., C.S.); Children's National Hospital and George Washington University Medical School (A.B.K., I.K., L.N.S.); Mount Sinai University and Bristol Myers Squibb (A.Y.).
Mark Gorman, From the Emory University SOM and Children's Healthcare of Atlanta (G.G., M. Morris); University of Virginia Health System (J.N.B.); University of California San Diego and Rady Children's Hospital San Diego (J.H.Y.); Boston Children's Hospital and Harvard Medical School (C.M.S., M.G.); University of Colorado SOM and Children's Hospital Colorado (R.K.); Seattle Children's/University of Washington (C.E.O.); Vanderbilt University Medical Center (N.V.); Children's Hospital Los Angeles and Keck School of Medicine (J.D.S.), University of Southern California; University of Texas at Austin and Dell Medical School (K.R.-L., M. Moodley, D.H.); New York University SOM (A.C., C.S.); Children's National Hospital and George Washington University Medical School (A.B.K., I.K., L.N.S.); Mount Sinai University and Bristol Myers Squibb (A.Y.).
Manikum Moodley, From the Emory University SOM and Children's Healthcare of Atlanta (G.G., M. Morris); University of Virginia Health System (J.N.B.); University of California San Diego and Rady Children's Hospital San Diego (J.H.Y.); Boston Children's Hospital and Harvard Medical School (C.M.S., M.G.); University of Colorado SOM and Children's Hospital Colorado (R.K.); Seattle Children's/University of Washington (C.E.O.); Vanderbilt University Medical Center (N.V.); Children's Hospital Los Angeles and Keck School of Medicine (J.D.S.), University of Southern California; University of Texas at Austin and Dell Medical School (K.R.-L., M. Moodley, D.H.); New York University SOM (A.C., C.S.); Children's National Hospital and George Washington University Medical School (A.B.K., I.K., L.N.S.); Mount Sinai University and Bristol Myers Squibb (A.Y.).
Duriel Hardy, From the Emory University SOM and Children's Healthcare of Atlanta (G.G., M. Morris); University of Virginia Health System (J.N.B.); University of California San Diego and Rady Children's Hospital San Diego (J.H.Y.); Boston Children's Hospital and Harvard Medical School (C.M.S., M.G.); University of Colorado SOM and Children's Hospital Colorado (R.K.); Seattle Children's/University of Washington (C.E.O.); Vanderbilt University Medical Center (N.V.); Children's Hospital Los Angeles and Keck School of Medicine (J.D.S.), University of Southern California; University of Texas at Austin and Dell Medical School (K.R.-L., M. Moodley, D.H.); New York University SOM (A.C., C.S.); Children's National Hospital and George Washington University Medical School (A.B.K., I.K., L.N.S.); Mount Sinai University and Bristol Myers Squibb (A.Y.).
Alexandra B. Kornbluh, From the Emory University SOM and Children's Healthcare of Atlanta (G.G., M. Morris); University of Virginia Health System (J.N.B.); University of California San Diego and Rady Children's Hospital San Diego (J.H.Y.); Boston Children's Hospital and Harvard Medical School (C.M.S., M.G.); University of Colorado SOM and Children's Hospital Colorado (R.K.); Seattle Children's/University of Washington (C.E.O.); Vanderbilt University Medical Center (N.V.); Children's Hospital Los Angeles and Keck School of Medicine (J.D.S.), University of Southern California; University of Texas at Austin and Dell Medical School (K.R.-L., M. Moodley, D.H.); New York University SOM (A.C., C.S.); Children's National Hospital and George Washington University Medical School (A.B.K., I.K., L.N.S.); Mount Sinai University and Bristol Myers Squibb (A.Y.).
Ilana Kahn, From the Emory University SOM and Children's Healthcare of Atlanta (G.G., M. Morris); University of Virginia Health System (J.N.B.); University of California San Diego and Rady Children's Hospital San Diego (J.H.Y.); Boston Children's Hospital and Harvard Medical School (C.M.S., M.G.); University of Colorado SOM and Children's Hospital Colorado (R.K.); Seattle Children's/University of Washington (C.E.O.); Vanderbilt University Medical Center (N.V.); Children's Hospital Los Angeles and Keck School of Medicine (J.D.S.), University of Southern California; University of Texas at Austin and Dell Medical School (K.R.-L., M. Moodley, D.H.); New York University SOM (A.C., C.S.); Children's National Hospital and George Washington University Medical School (A.B.K., I.K., L.N.S.); Mount Sinai University and Bristol Myers Squibb (A.Y.).
Leigh N. Sepeta, From the Emory University SOM and Children's Healthcare of Atlanta (G.G., M. Morris); University of Virginia Health System (J.N.B.); University of California San Diego and Rady Children's Hospital San Diego (J.H.Y.); Boston Children's Hospital and Harvard Medical School (C.M.S., M.G.); University of Colorado SOM and Children's Hospital Colorado (R.K.); Seattle Children's/University of Washington (C.E.O.); Vanderbilt University Medical Center (N.V.); Children's Hospital Los Angeles and Keck School of Medicine (J.D.S.), University of Southern California; University of Texas at Austin and Dell Medical School (K.R.-L., M. Moodley, D.H.); New York University SOM (A.C., C.S.); Children's National Hospital and George Washington University Medical School (A.B.K., I.K., L.N.S.); Mount Sinai University and Bristol Myers Squibb (A.Y.).
Anusha Yeshokumar, From the Emory University SOM and Children's Healthcare of Atlanta (G.G., M. Morris); University of Virginia Health System (J.N.B.); University of California San Diego and Rady Children's Hospital San Diego (J.H.Y.); Boston Children's Hospital and Harvard Medical School (C.M.S., M.G.); University of Colorado SOM and Children's Hospital Colorado (R.K.); Seattle Children's/University of Washington (C.E.O.); Vanderbilt University Medical Center (N.V.); Children's Hospital Los Angeles and Keck School of Medicine (J.D.S.), University of Southern California; University of Texas at Austin and Dell Medical School (K.R.-L., M. Moodley, D.H.); New York University SOM (A.C., C.S.); Children's National Hospital and George Washington University Medical School (A.B.K., I.K., L.N.S.); Mount Sinai University and Bristol Myers Squibb (A.Y.).

Document Type

Journal Article

Publication Date

7-1-2023

Journal

Neurology(R) neuroimmunology & neuroinflammation

Volume

10

Issue

4

DOI

10.1212/NXI.0000000000200130

Abstract

OBJECTIVES: How brain MRI lesions associate with outcomes in pediatric anti-NMDA receptor encephalitis (pNMDARE) is unknown. In this study, we correlate T2-hyperintense MRI brain lesions with clinical outcomes in pNMDARE. METHODS: This was a multicenter retrospective cohort study from 11 institutions. Children younger than 18 years with pNMDARE were included. One-year outcomes were assessed by the modified Rankin Score (mRS) with good (mRS ≤2) and poor (mRS ≥3) outcomes. RESULTS: A total of 175 pNMDARE subjects were included, with 1-year mRS available in 142/175 (81%) and 60/175 (34%) had abnormal brain MRIs. The most common T2-hyperintense lesion locations were frontal, temporal, and parietal. MRI features that predicted poor 1-year outcomes included abnormal MRI, particularly T2 lesions in the frontal and occipital lobes. After adjusting for treatment within 4 weeks of onset, improvement within 4 weeks, and intensive care unit admission, MRI features were no longer associated with poor outcomes, but after multiple imputation for missing data, T2 frontal and occipital lesions associated with poor outcomes. DISCUSSION: Abnormal frontal and occipital lesions on MRI may associate with 1-year mRS in pNMDARE. MRI of the brain may be a helpful prognostication tool that should be examined in future studies.

Department

Neurology

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