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Progressive cortical and sub-cortical alterations in patients with anti-N-methyl-d-aspartate receptor encephalitis

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Abstract

Background

Advanced structural analyses are increasingly being highly valued to uncover pathophysiological understanding of anti-N-methyl-d-aspartate receptor (NMDAR) encephalitis. Therefore, we aimed to explore whether and how antibody-mediated NMDAR dysfunction affected cortical and sub-cortical brain morphology and their relationship with clinical symptoms.

Methods

We performed surface-based morphometry analyses, hippocampal segmentation, and correlational analyses in 24 patients with anti-NMDAR encephalitis after acute disease stage and 30 normal controls (NC) in this case–control study.

Results

Patients showed significantly decreased cortical alterations mainly in language network (LN) and default mode network (DMN), as well as decreased gray matter volume in left cornu ammonis 1 (CA1) body of hippocampus. Further correlation analyses showed that the decreased cortical thickness in the right superior frontier gyrus was associated with decreased cognitive scores, the decreased cortical volume in the right pars triangulari and decreased surface area in the right pars operculari were associated with decreased memory scores, whereas decreased gray matter volume in the left CA1 body was significantly correlated with longer time between first symptom and imaging in the patients.

Conclusion

These results suggested that cognitive impairments resulted from long-term sequelae of the encephalitis were mainly associated with cortical alterations in LN and DMN and sub-cortical atrophy of left CA1 body, which can be served as effective features to assess disease progression in clinical routine examination.

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Data availability statement

The data used in this study are in-house data and can be available upon reasonable request from the corresponding author.

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Funding

This work was supported by funding from the National Natural Science Foundation of China (62006220), the Science Fund for Distinguished Young Scholars of Anhui Province (1808085J23), and Shenzhen Science and Technology Research Program (JCYJ20200109114816594).

Author information

Author notes

  1. Jinping Xu and Yuanyuan Guo contributed equally in the current paper.

Authors and Affiliations

  1. Institute of Biomedical and Health Engineering, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, 10068 Xueyuan Road, Shenzhen, Guangdong Province, China

    Jinping Xu, Jiaying Li, Jinhuan Zhang & Qingmao Hu

  2. Department of Neurology, The First Affiliated Hospital of Anhui Medical University, 218 Jixi Road, Hefei, Anhui Province, China

    Yuanyuan Guo, Juanjuan Zhang, Kai Wang & Yanghua Tian

  3. Department of Neurology, Division of Life Sciences and Medicine, The First Affiliated Hospital of USTC, University of Science and Technology of China, Hefei, 230001, China

    Xinyi Lv

  4. The School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei, 230032, China

    Kai Wang

  5. Institute of Artificial Intelligence, Hefei Comprehensive National Science Center, Hefei, 230088, China

    Kai Wang & Yanghua Tian

  6. Anhui Province Key Laboratory of Cognition and Neuropsychiatric Disorders, Hefei, 230022, China

    Kai Wang & Yanghua Tian

  7. Collaborative Innovation Center of Neuropsychiatric Disorders and Mental Health, Hefei, 230022, China

    Kai Wang & Yanghua Tian

Authors
  1. Jinping Xu
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  2. Yuanyuan Guo
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Contributions

QH, YT, and KW designed the study. YG, XL, and JZ collected the data. JX, JZ, and JL analyzed the data. JX and JL wrote the manuscript. All authors discussed the results and reviewed the manuscript.

Corresponding authors

Correspondence to Qingmao Hu, Kai Wang or Yanghua Tian.

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Conflicts of interest

All authors have no competing interests to declare.

Ethical standard statement

The study was approved by the ethical committee of Anhui Medical University, and written informed consents were obtained from all participants according to the Declaration of Helsinki.

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Xu, J., Guo, Y., Li, J. et al. Progressive cortical and sub-cortical alterations in patients with anti-N-methyl-d-aspartate receptor encephalitis. J Neurol 269, 389–398 (2022). https://doi.org/10.1007/s00415-021-10643-1

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  • DOI: https://doi.org/10.1007/s00415-021-10643-1

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