Department of Neurology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.
Guangdong Provincial Key Laboratory of Diagnosis and Treatment of Major Neurological Diseases, National Key Clinical Department and Key Discipline of Neurology, Guangzhou, China.
Acta Neurol Scand. 2020 Nov;142(5):460-465. doi: 10.1111/ane.13298. Epub 2020 Jul 6.
Seizures are a prominent feature of anti-N-methyl-d-aspartate receptor (anti-NMDAR) encephalitis. Nearly half of brain magnetic resonance image (MRI) results are abnormal. The aim of our study was to evaluate the associations between seizures and brain MRI results in patients with anti-NMDAR encephalitis.
Patients with anti-NMDAR encephalitis were enrolled between January 2015 and December 2018. The patients included were divided into normal and abnormal MRI groups. Seizure outcomes and modified Rankin Scale scores at the 1-year follow-up were assessed. Seizure characteristics and outcomes were compared between groups.
Of 35 patients with anti-NMDAR encephalitis, 28 patients (80%) had reported seizures in the acute phase. Patients with abnormal MRI findings more frequently had focal seizures than patients with normal MRI findings (72.7% vs 17.6%, P < .01). The incidence of patients treated with 2 or more antiepileptic drugs was higher in the normal MRI group than in the abnormal MRI group (100% vs 45.4%, P < .01). The onset-immunotherapy time was shorter in the abnormal MRI group than in the normal MRI group (P < .05). There were no statistically significant differences in seizure outcomes between the normal and abnormal MRI groups (P > .05).
Focal seizures were most common in patients with abnormal MRI lesions. In the acute stage of the disease, the abnormal MRI group was more likely than the normal MRI group to achieve seizure control. Abnormal MRI findings did not affect the overall good prognosis of patients with anti-NMDAR encephalitis with seizures.
癫痫发作是抗 N-甲基-D-天冬氨酸受体（anti-NMDAR）脑炎的突出特征。近半数的脑磁共振成像（MRI）结果异常。本研究旨在评估抗 NMDAR 脑炎患者癫痫发作与脑 MRI 结果之间的关系。
2015 年 1 月至 2018 年 12 月期间，招募了抗 NMDAR 脑炎患者。将患者分为 MRI 正常组和异常组。评估 1 年随访时的癫痫发作结局和改良 Rankin 量表评分。比较两组之间的癫痫发作特征和结局。
在 35 例抗 NMDAR 脑炎患者中，28 例（80%）在急性期有癫痫发作报告。MRI 结果异常的患者比 MRI 结果正常的患者更常出现局灶性癫痫发作（72.7%比 17.6%，P<.01）。MRI 正常组患者使用 2 种或更多种抗癫痫药物治疗的发生率高于 MRI 异常组（100%比 45.4%，P<.01）。MRI 异常组的发病-免疫治疗时间短于 MRI 正常组（P<.05）。MRI 正常组和异常组的癫痫发作结局无统计学差异（P>.05）。
MRI 病变异常组患者更常出现局灶性癫痫发作。在疾病的急性期，MRI 异常组比 MRI 正常组更有可能控制癫痫发作。MRI 异常发现并不影响抗 NMDAR 脑炎伴癫痫发作患者的总体良好预后。
