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Fluorodeoxyglucose positron emission tomography in anti-N-methyl-D-aspartate receptor encephalitis: distinct pattern of disease.
J Neurol Neurosurg Psychiatry. 2012 Jul; 83(7):681-6.JN

Abstract

BACKGROUND

Patients with encephalitis associated with antibodies against N-methyl-D-aspartate-receptor antibody (NMDAR-ab) encephalitis frequently show psychotic symptoms, amnesia, seizures and movement disorders. While brain MRI in NMDAR-ab encephalitis is often normal, abnormalities of cerebral glucose metabolism have been demonstrated by positron emission tomography (PET) with 18F-fluorodeoxyglucose(FDG) in a few usually isolated case reports. However, a common pattern of FDG-PET abnormalities has not been reported.

METHODS

The authors retrospectively identified six patients with NMDAR-ab encephalitis in two large German centres who underwent at least one whole-body FDG-PET for tumour screening between January 2007 and July 2010. They analysed the pattern of cerebral uptake derived from whole-body PET data for characteristic changes of glucose metabolism compared with controls, and the changes of this pattern during the course of the disease.

RESULTS

Groupwise analysis revealed that patients with NMDAR-ab encephalitis showed relative frontal and temporal glucose hypermetabolism associated with occipital hypometabolism. Cross-sectional analysis of the group demonstrated that the extent of these changes is positively associated with clinical disease severity. Longitudinal analysis of two cases showed normalisation of the pattern of cerebral glucose metabolism with recovery.

CONCLUSIONS

A characteristic change in cerebral glucose metabolism during NMDAR-ab encephalitis is an increased frontotemporal-to-occipital gradient. This pattern correlates with disease severity. Similar changes have been observed in psychosis induced by NMDAR antagonists. Thus, this pattern might be a consequence of impaired NMDAR function.

Authors+Show Affiliations

Department of Neurology, University Medical Center Eppendorf, Martinistr 52, Hamburg, Germany. f.leypoldt@uke.uni-hamburg.deNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

22566598

Citation

Leypoldt, Frank, et al. "Fluorodeoxyglucose Positron Emission Tomography in anti-N-methyl-D-aspartate Receptor Encephalitis: Distinct Pattern of Disease." Journal of Neurology, Neurosurgery, and Psychiatry, vol. 83, no. 7, 2012, pp. 681-6.
Leypoldt F, Buchert R, Kleiter I, et al. Fluorodeoxyglucose positron emission tomography in anti-N-methyl-D-aspartate receptor encephalitis: distinct pattern of disease. J Neurol Neurosurg Psychiatry. 2012;83(7):681-6.
Leypoldt, F., Buchert, R., Kleiter, I., Marienhagen, J., Gelderblom, M., Magnus, T., Dalmau, J., Gerloff, C., & Lewerenz, J. (2012). Fluorodeoxyglucose positron emission tomography in anti-N-methyl-D-aspartate receptor encephalitis: distinct pattern of disease. Journal of Neurology, Neurosurgery, and Psychiatry, 83(7), 681-6. https://doi.org/10.1136/jnnp-2011-301969
Leypoldt F, et al. Fluorodeoxyglucose Positron Emission Tomography in anti-N-methyl-D-aspartate Receptor Encephalitis: Distinct Pattern of Disease. J Neurol Neurosurg Psychiatry. 2012;83(7):681-6. PubMed PMID: 22566598.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Fluorodeoxyglucose positron emission tomography in anti-N-methyl-D-aspartate receptor encephalitis: distinct pattern of disease. AU - Leypoldt,Frank, AU - Buchert,Ralph, AU - Kleiter,Ingo, AU - Marienhagen,Jörg, AU - Gelderblom,Mathias, AU - Magnus,Tim, AU - Dalmau,Josep, AU - Gerloff,Christian, AU - Lewerenz,Jan, Y1 - 2012/05/07/ PY - 2012/5/9/entrez PY - 2012/5/9/pubmed PY - 2012/8/17/medline SP - 681 EP - 6 JF - Journal of neurology, neurosurgery, and psychiatry JO - J. Neurol. Neurosurg. Psychiatry VL - 83 IS - 7 N2 - BACKGROUND: Patients with encephalitis associated with antibodies against N-methyl-D-aspartate-receptor antibody (NMDAR-ab) encephalitis frequently show psychotic symptoms, amnesia, seizures and movement disorders. While brain MRI in NMDAR-ab encephalitis is often normal, abnormalities of cerebral glucose metabolism have been demonstrated by positron emission tomography (PET) with 18F-fluorodeoxyglucose(FDG) in a few usually isolated case reports. However, a common pattern of FDG-PET abnormalities has not been reported. METHODS: The authors retrospectively identified six patients with NMDAR-ab encephalitis in two large German centres who underwent at least one whole-body FDG-PET for tumour screening between January 2007 and July 2010. They analysed the pattern of cerebral uptake derived from whole-body PET data for characteristic changes of glucose metabolism compared with controls, and the changes of this pattern during the course of the disease. RESULTS: Groupwise analysis revealed that patients with NMDAR-ab encephalitis showed relative frontal and temporal glucose hypermetabolism associated with occipital hypometabolism. Cross-sectional analysis of the group demonstrated that the extent of these changes is positively associated with clinical disease severity. Longitudinal analysis of two cases showed normalisation of the pattern of cerebral glucose metabolism with recovery. CONCLUSIONS: A characteristic change in cerebral glucose metabolism during NMDAR-ab encephalitis is an increased frontotemporal-to-occipital gradient. This pattern correlates with disease severity. Similar changes have been observed in psychosis induced by NMDAR antagonists. Thus, this pattern might be a consequence of impaired NMDAR function. SN - 1468-330X UR - https://www.unboundmedicine.com/medline/citation/22566598/Fluorodeoxyglucose_positron_emission_tomography_in_anti_N_methyl_D_aspartate_receptor_encephalitis:_distinct_pattern_of_disease_ L2 - http://jnnp.bmj.com/cgi/pmidlookup?view=long&pmid=22566598 DB - PRIME DP - Unbound Medicine ER -