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Cerebral (18)FluoroDeoxy-Glucose Positron Emission Tomography in paediatric anti N-methyl-D-aspartate receptor encephalitis: A case series.
Brain Dev. 2016 May; 38(5):461-70.BD

Abstract

BACKGROUND

Anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis is a frequent and severe cause of encephalitis in children with potential efficient treatment (immunotherapy). Suggestive clinical features are behavioural troubles, seizures and movement disorders. Prompt diagnosis and treatment initiation are needed to guarantee favourable outcome. Nevertheless, diagnosis may be challenging because of the classical ancillary test (magnetic resonance imaging (MRI), electroencephalogram, standard cerebro-spinal fluid analysis) have limited sensitivity. Currently, immunological analyses are needed for the diagnostic confirmation. In adult patients, some studies suggested a potential role of cerebral (18)FluoroDeoxy-Glucose Positron Emission Tomography (FDG-PET) in the evaluation of anti-NMDAR encephalitis. Nevertheless, almost no data exist in paediatric population.

METHOD

We report retrospectively clinical, ancillary tests and cerebral FDG-PET data in 6 young patients (median age=10.5 years, 4 girls) with immunologically confirmed anti-NMDAR encephalitis.

RESULTS

Our patients presented classical clinical features of anti-NMDAR encephalitis with severe course (notably four patients had normal MRI). Our series shows the feasibility and the good sensitivity of cerebral FDG-PET (6/6 patients with brain metabolism alteration) in paediatric population. We report some particular features in this population: extensive, symmetric cortical hypometabolism especially in posterior areas; asymmetric anterior focus of hypermetabolism; and basal ganglia hypermetabolism. We found also a good correlation between the clinical severity and the cerebral metabolism changes. Moreover, serial cerebral FDG-PET showed parallel brain metabolism and clinical improvement.

CONCLUSION

Our study reveals the existence of specific patterns of brain metabolism alteration in anti-NMDAR encephalitis in paediatric population.

Authors+Show Affiliations

APHM, Timone Hospital, Paediatric Neurology Department, 13005 Marseille, France. Electronic address: stanislas.lagarde@ap-hm.fr.APHM, Timone Hospital, Paediatric Neurology Department, 13005 Marseille, France.APHM, Timone Hospital, Paediatric Neurology Department, 13005 Marseille, France.Aix Marseille Université, CNRS, CRN2M UMR 7286, 13344 Marseille, France.Aix Marseille Université, CNRS, CRN2M UMR 7286, 13344 Marseille, France.APHM, Timone Hospital, Paediatric Neurology Department, 13005 Marseille, France.APHM, Timone Hospital, Paediatric Neurology Department, 13005 Marseille, France.APHM, Timone Hospital, Nuclear Medicine Department, 13005 Marseille, France.

Pub Type(s)

Case Reports
Journal Article

Language

eng

PubMed ID

26542469

Citation

Lagarde, Stanislas, et al. "Cerebral (18)FluoroDeoxy-Glucose Positron Emission Tomography in Paediatric Anti N-methyl-D-aspartate Receptor Encephalitis: a Case Series." Brain & Development, vol. 38, no. 5, 2016, pp. 461-70.
Lagarde S, Lepine A, Caietta E, et al. Cerebral (18)FluoroDeoxy-Glucose Positron Emission Tomography in paediatric anti N-methyl-D-aspartate receptor encephalitis: A case series. Brain Dev. 2016;38(5):461-70.
Lagarde, S., Lepine, A., Caietta, E., Pelletier, F., Boucraut, J., Chabrol, B., Milh, M., & Guedj, E. (2016). Cerebral (18)FluoroDeoxy-Glucose Positron Emission Tomography in paediatric anti N-methyl-D-aspartate receptor encephalitis: A case series. Brain & Development, 38(5), 461-70. https://doi.org/10.1016/j.braindev.2015.10.013
Lagarde S, et al. Cerebral (18)FluoroDeoxy-Glucose Positron Emission Tomography in Paediatric Anti N-methyl-D-aspartate Receptor Encephalitis: a Case Series. Brain Dev. 2016;38(5):461-70. PubMed PMID: 26542469.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Cerebral (18)FluoroDeoxy-Glucose Positron Emission Tomography in paediatric anti N-methyl-D-aspartate receptor encephalitis: A case series. AU - Lagarde,Stanislas, AU - Lepine,Anne, AU - Caietta,Emilie, AU - Pelletier,Florence, AU - Boucraut,José, AU - Chabrol,Brigitte, AU - Milh,Mathieu, AU - Guedj,Eric, Y1 - 2015/11/02/ PY - 2015/07/15/received PY - 2015/09/15/revised PY - 2015/10/20/accepted PY - 2015/11/7/entrez PY - 2015/11/7/pubmed PY - 2017/1/31/medline KW - Anti-NMDAR KW - Autoimmune KW - Brain FDG-PET KW - Cerebral FDG-PET KW - Children KW - Encephalitis KW - FluoroDeoxy-Glucose Positron Emission Tomography KW - N-methyl-d-aspartate KW - Rituximab SP - 461 EP - 70 JF - Brain & development JO - Brain Dev VL - 38 IS - 5 N2 - BACKGROUND: Anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis is a frequent and severe cause of encephalitis in children with potential efficient treatment (immunotherapy). Suggestive clinical features are behavioural troubles, seizures and movement disorders. Prompt diagnosis and treatment initiation are needed to guarantee favourable outcome. Nevertheless, diagnosis may be challenging because of the classical ancillary test (magnetic resonance imaging (MRI), electroencephalogram, standard cerebro-spinal fluid analysis) have limited sensitivity. Currently, immunological analyses are needed for the diagnostic confirmation. In adult patients, some studies suggested a potential role of cerebral (18)FluoroDeoxy-Glucose Positron Emission Tomography (FDG-PET) in the evaluation of anti-NMDAR encephalitis. Nevertheless, almost no data exist in paediatric population. METHOD: We report retrospectively clinical, ancillary tests and cerebral FDG-PET data in 6 young patients (median age=10.5 years, 4 girls) with immunologically confirmed anti-NMDAR encephalitis. RESULTS: Our patients presented classical clinical features of anti-NMDAR encephalitis with severe course (notably four patients had normal MRI). Our series shows the feasibility and the good sensitivity of cerebral FDG-PET (6/6 patients with brain metabolism alteration) in paediatric population. We report some particular features in this population: extensive, symmetric cortical hypometabolism especially in posterior areas; asymmetric anterior focus of hypermetabolism; and basal ganglia hypermetabolism. We found also a good correlation between the clinical severity and the cerebral metabolism changes. Moreover, serial cerebral FDG-PET showed parallel brain metabolism and clinical improvement. CONCLUSION: Our study reveals the existence of specific patterns of brain metabolism alteration in anti-NMDAR encephalitis in paediatric population. SN - 1872-7131 UR - https://www.unboundmedicine.com/medline/citation/26542469/Cerebral__18_FluoroDeoxy_Glucose_Positron_Emission_Tomography_in_paediatric_anti_N_methyl_D_aspartate_receptor_encephalitis:_A_case_series_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0387-7604(15)00225-9 DB - PRIME DP - Unbound Medicine ER -