MRI Features and their Association with Outcomes in Children with Anti-NMDA Receptor Encephalitis (S22.003)

Abstract

<h3>Objective:</h3> To correlate MRI brain lesions with clinical outcomes in pediatric anti-NMDA receptor encephalitis (pNMDARE). <h3>Background:</h3> Up to 50% of MRIs in NMDARE are reportedly abnormal. However, data is limited on range and types of abnormalities, and also how abnormal MRIs associate with outcomes in pNMDARE. <h3>Design/Methods:</h3> This was a multi-center retrospective cohort study with ten institutions. NMDARE was defined as positive CSF NMDA-receptor antibody and at least one neuropsychiatric symptom. Patients with prior HSV encephalitis were excluded. Outcomes were assessed by the modified Rankin Score (mRS) at 1 year with good (mRS ≤ 2) and poor (mRS ≥ 3) outcomes and also for full recovery (mRS=0) versus incomplete recovery (mRS&gt;0). Statistical analyses were performed using SAS 16.0 (Cary, NC). <h3>Results:</h3> A total of 169 patients with pNMDARE were included, with one-year mRS available in 134/169 (79%). Abnormal MRIs were found in 59/169 (35%), and were associated with an increased likelihood of intubation and ICU admission (chi-square, p = 0.038 and p=0.045, respectively). The most common T2 FLAIR lesion locations were frontal (29/59, 49%), temporal (28/59, 47%), parietal (19/59, 32%), and hippocampal lesions (11/59, 19%). MRI enhancement was seen in 34/165 (21%) and MRI brain atrophy was seen in 4% (6/168). MRI features that predicted incomplete recovery at one year (mRS &gt; 0) was the presence of T2 frontal lobe lesions (chi-square, p = 0.0427). G-tube placement and intubation also predicted incomplete recovery. On multivariable logistic regression analysis using backward selection, one-year mRS was associated with: intubation (OR 0.232, 95%CI 0.103–0.526) and T2 frontal lesions on MRI (OR 0.373, 95% 0.148–0.938). <h3>Conclusions:</h3> Abnormal frontal lesions on MRI along with intubation may associate with one-year mRS in pNMDARE. MRIs may be a helpful tool for prognostication, which will be examined in future studies. <b>Disclosure:</b> The institution of Dr. Gombolay has received research support from CDC. The institution of Dr. Gombolay has received research support from NIH. Dr. Brenton has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Cycle Pharmaceuticals. The institution of Dr. Brenton has received research support from NIH/NINDS. Dr. Brenton has received personal compensation in the range of $500-$4,999 for serving as a Grant Reviewer with Department of Defense. Dr. Brenton has received personal compensation in the range of $500-$4,999 for serving as a Expert Interview with MDEdge. Dr. Brenton has received personal compensation in the range of $0-$499 for serving as a Grant Reviewer with NIH. Dr. Yang has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Neurology Live. Dr. Yang has received research support from United Mitochondrial Disease Foundation. The institution of Dr. Stredny has received research support from Pediatric Epilepsy Research Foundation. The institution of Dr. Kammeyer has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Genentech. The institution of Dr. Kammeyer has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Sanofi-Genzyme. Dr. Kammeyer has received personal compensation in the range of $500-$4,999 for serving as an Expert Witness for Ogborn-Mihm Trial Lawyers. The institution of Dr. Kammeyer has received research support from Rocky Mountain Multiple Sclerosis Center. The institution of Dr. Otten has received research support from CDC. Dr. Vu has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Syneos Health. Dr. Santoro has received personal compensation for serving as an employee of UCB. Dr. Santoro has received personal compensation for serving as an employee of Cycle Pharma. Dr. ROBLES LOPEZ has nothing to disclose. Dr. Christiana has nothing to disclose. The institution of Dr. Steriade has received research support from NIH. The institution of Dr. Steriade has received research support from Dorris Duke Fund to Retain Clinician Scientists. Miss Morris has received personal compensation in the range of $10,000-$49,999 for serving as a Research Assistant/Specialist with Emory University, School of Medicine, Department of Pediatrics, Division of Neurology. The institution of Dr. Gorman has received research support from Pfizer. The institution of Dr. Gorman has received research support from Roche / Genetech . Dr. Moodley has nothing to disclose. Dr. Hardy has nothing to disclose. Dr. Kornbluh has nothing to disclose. Ilana Kahn has nothing to disclose. Dr. Sepeta has received personal compensation in the range of $500,000-$999,999 for serving as a Grant PI with Nih. Dr. Sepeta has a non-compensated relationship as a Special volunteer with Nih that is relevant to AAN interests or activities. Dr. Yeshokumar has nothing to disclose.