PT  - JOURNAL ARTICLE
AU  - Owen Robert Phillips
AU  - Shantanu H Joshi
AU  - Katherine L Narr
AU  - David W Shattuck
AU  - Manpreet Singh
AU  - Margherita Di Paola
AU  - Christoph J Ploner
AU  - Harald Prüss
AU  - Paul Friedemann
AU  - Carsten Finke
TI  - Superficial white matter damage in anti-NMDA receptor encephalitis
AID  - 10.1136/jnnp-2017-316822
DP  - 2017 Nov 03
TA  - Journal of Neurology, Neurosurgery & Psychiatry
PG  - jnnp-2017-316822
4099  - http://jnnp.bmj.com/content/early/2017/11/03/jnnp-2017-316822.short
4100  - http://jnnp.bmj.com/content/early/2017/11/03/jnnp-2017-316822.full
AB  - Background Clinical brain MRI is normal in the majority of patients with anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis. However, extensive deep white matter damage wasrecently identifiedin these patients using diffusion weighted imaging. Here, our aim was to study a particularly vulnerable brain compartment, the late myelinating superficial white matter.Methods Forty-six patients with anti-NMDAR encephalitis were included. Ten out of these were considered neurologically recovered (modified Rankin scale of zero), while 36 patients were non-recovered. In addition, 30 healthy controls were studied. MRI data were collected from all subjects and superficial white matter mean diffusivity derived from diffusion tensor imaging was compared between groups in whole brain, lobar and vertex-based analyses. Patients underwent comprehensive cognitive testing, and correlation analyses were performed between cognitive performance and superficial white matter integrity.Results Non-recovered patients showed widespread superficial white matter damage in comparison to recovered patients and healthy controls. Vertex-based analyses revealed that damage predominated in frontal and temporal lobes. In contrast, the superficial white matter was intact in recovered patients. Importantly, persistent cognitive impairments in working memory, verbal memory, visuospatial memory and attention significantly correlated with damage of the superficial white matter in patients.Conclusions Anti-NMDAR encephalitis is associated with extensive superficial white matter damage in patients with incomplete recovery. The strong association with impairment in several cognitive domains highlights the clinical relevance of white matter damage in this disorder and warrants investigations of the underlying pathophysiological mechanisms.