Associations between seizures and MRI in patients with anti-NMDAR encephalitis
Associations between seizures and MRI in patients with anti-NMDAR encephalitis
复制标题
抗 NMDAR 脑炎患者癫痫发作与 MRI 之间的关联
DOI：
10.1111/ane.13298
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发表时间：
2020-07-06
影响因子：
3.5
通讯作者：
Chen, Ziyi
中科院分区：
文献类型：
--
作者：
Ni, Guanzhong;Lin, Wanrong;Chen, Ziyi
目的癫痫发作是抗N-甲基-d-天冬氨酸受体（抗NMDAR）脑炎的一个显著特征。近一半的脑磁共振成像（MRI）结果异常。本研究的目的是评估抗NMDAR脑炎患者癫痫发作与脑MRI结果之间的相关性。方法2015年1月至2018年12月期间入组抗NMDAR脑炎患者。将纳入的患者分为MRI正常组和异常组。评估1年随访时的癫痫结局和改良兰金量表评分。比较两组的癫痫发作特征和结局。结果35例抗NMDAR脑炎患者中，28例（80%）在急性期报告癫痫发作。MRI异常者局灶性癫痫发作率明显高于MRI正常者（72.7%vs17.6%，P <0.01）。MRI正常组患者使用2种或2种以上抗癫痫药物的发生率高于MRI异常组（100%vs45.4%，P <0.01）。MRI异常组免疫治疗起效时间短于MRI正常组（P <0.05）。MRI正常组和异常组之间的癫痫发作结局无统计学显著差异（P > 0.05）。结论局灶性癫痫发作多见于MRI异常病灶。在疾病的急性期，MRI异常组比MRI正常组更容易达到癫痫控制。MRI异常并不影响抗NMDAR脑炎伴癫痫发作患者的总体良好预后。
Objectives 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. Methods 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. Results 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). Conclusions 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.