Abstract
Objective: To evaluate the utility of electroencephalography (EEG) changes as diagnostic and prognostic biomarkers in acute autoimmune encephalitis (AIE). Methods: One hundred and thirty-one patients with AIE were recruited retrospectively across 7 hospitals. Clinical data were collected during admission and at 12 months. EEGs were reviewed using a standard reporting proforma. Associations between EEG biomarkers, AIE subtypes, and clinical outcomes were assessed using logistic regression modeling. Results: Presence of superimposed fast activity (OR 34.33; 95% CI 3.90, 4527.27; p < 0.001), fluctuating EEG abnormality (OR 6.60; 95% CI 1.60, 37.59; p = 0.008), and hemispheric focality (OR 28.48; 95% CI 3.14, 3773.14; p < 0.001) were significantly more common in N-methyl-D-aspartate receptor (NMDAR) antibody-associated patients with AIE compared to other AIE subtypes. Abnormal background rhythm was associated with a poor mRS (modified Rankin score) at discharge (OR 0.29; 95% CI 0.10, 0.75; p = 0.01) and improvement in mRS at 12 months compared with admission mRS (3.72; 95% CI 1.14, 15.23; p = 0.04). Significance: We have identified EEG biomarkers that differentiate NMDAR AIE from other subtypes. We have also demonstrated EEG biomarkers that are associated with poor functional outcomes.
Original language | English |
---|---|
Article number | 108571 |
Number of pages | 11 |
Journal | Epilepsy & Behavior |
Volume | 128 |
DOIs | |
Publication status | Published - Mar 2022 |
Keywords
- Autoimmune encephalitis
- Biomarker
- EEG
- LGI-1
- NMDA
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In: Epilepsy & Behavior, Vol. 128, 108571, 03.2022.
Research output: Contribution to journal › Article › Research › peer-review
TY - JOUR
T1 - Electroclinical biomarkers of autoimmune encephalitis
AU - Wesselingh, Robb
AU - Broadley, James
AU - Buzzard, Katherine
AU - Tarlinton, David
AU - Seneviratne, Udaya
AU - Kyndt, Chris
AU - Stankovich, Jim
AU - Sanfilippo, Paul
AU - Nesbitt, Cassie
AU - D'Souza, Wendyl
AU - Macdonell, Richard
AU - Butzkueven, Helmut
AU - O'Brien, Terence J.
AU - Monif, Mastura
N1 - Funding Information: A/Prof Wendyl D’Souza’s salary is part-funded by The University of Melbourne. He has received travel, investigator-initiated, scientific advisory board and speaker honoraria from UCB Pharma Australia & Global; investigator-initiated, scientific advisory board, travel and speaker honoraria from Eisai Australia & Global; advisory board honoraria from Liva Nova; educational grants from Novartis Pharmaceuticals, Pfizer Pharmaceuticals and Sanofi-Synthelabo; educational; travel and fellowship grants from GSK Neurology Australia, and honoraria from SciGen Pharmaceuticals. Funding Information: We would like to thank Callum Hollis, Ramja Kokulan, Patrick Carney, Annie Roten, and John Archer for their assistance in the procurement and review of EEG data, and the Australian Autoimmune Encephalitis Consortium for their support of the project. A/Prof Wendyl D'Souza?s salary is part-funded by The University of Melbourne. He has received travel, investigator-initiated, scientific advisory board and speaker honoraria from UCB Pharma Australia & Global; investigator-initiated, scientific advisory board, travel and speaker honoraria from Eisai Australia & Global; advisory board honoraria from Liva Nova; educational grants from Novartis Pharmaceuticals, Pfizer Pharmaceuticals and Sanofi-Synthelabo; educational; travel and fellowship grants from GSK Neurology Australia, and honoraria from SciGen Pharmaceuticals. Dr Katherine Buzzard has received support to attend educational events from Sanofi Genzyme, Teva, Biogen, Merck, Roche and Novartis, has received honorarium for presentations from Teva, Sanofi Genzyme and Biogen, and has served on the Advisory Board for Merck. Prof Richard Macdonell reports no disclosures. Prof Helmut Butzkueven's research is funded by an Australian National Health Medical Research Council Investigator Grant. His institution receives funding from Biogen, Roche, Merck, Alexion and Novartis for speaker engagements, study steering and advisory committee service. He is on the editorial board of Multiple Sclerosis and Related Disorders and the Steering committee of the Brain Health Initiative (Oxford Health Policy Forum). Prof Terence J. O'Brien receives research funding from Biogen, UCB Pharma, Eisai Pharma, Anavex Pharmaceuticals, Zynerba Pharmaceuticals, and serves on the scientific advisory boards for UCB Pharma, Eisai Pharmaceuticals, Zynerba Pharmaceuticals, ES Therapeutics, Seqirus Pharmaceuticals. Dr Mastura Monif? has served on advisory board for Merck, and has received speaker honoraria from Merck and Biogen. Her institution receives funding from Merck, Australian National Health Medical Research Council, Brain Foundation, Charles and Sylvia Viertel Foundation, Bethlehem and Griffith Foundation and MS Research Australia. The remaining authors report no conflicts of interest. We confirm that we have read the Journal's position on issues involved in ethical publication and affirm that this report is consistent with those guidelines. Funding Information: Dr Mastura Monif’ has served on advisory board for Merck, and has received speaker honoraria from Merck and Biogen. Her institution receives funding from Merck, Australian National Health Medical Research Council, Brain Foundation, Charles and Sylvia Viertel Foundation, Bethlehem and Griffith Foundation and MS Research Australia. Funding Information: Prof Helmut Butzkueven’s research is funded by an Australian National Health Medical Research Council Investigator Grant. His institution receives funding from Biogen, Roche, Merck, Alexion and Novartis for speaker engagements, study steering and advisory committee service. He is on the editorial board of Multiple Sclerosis and Related Disorders and the Steering committee of the Brain Health Initiative (Oxford Health Policy Forum). Publisher Copyright: © 2022 Elsevier Inc.
PY - 2022/3
Y1 - 2022/3
N2 - Objective: To evaluate the utility of electroencephalography (EEG) changes as diagnostic and prognostic biomarkers in acute autoimmune encephalitis (AIE). Methods: One hundred and thirty-one patients with AIE were recruited retrospectively across 7 hospitals. Clinical data were collected during admission and at 12 months. EEGs were reviewed using a standard reporting proforma. Associations between EEG biomarkers, AIE subtypes, and clinical outcomes were assessed using logistic regression modeling. Results: Presence of superimposed fast activity (OR 34.33; 95% CI 3.90, 4527.27; p < 0.001), fluctuating EEG abnormality (OR 6.60; 95% CI 1.60, 37.59; p = 0.008), and hemispheric focality (OR 28.48; 95% CI 3.14, 3773.14; p < 0.001) were significantly more common in N-methyl-D-aspartate receptor (NMDAR) antibody-associated patients with AIE compared to other AIE subtypes. Abnormal background rhythm was associated with a poor mRS (modified Rankin score) at discharge (OR 0.29; 95% CI 0.10, 0.75; p = 0.01) and improvement in mRS at 12 months compared with admission mRS (3.72; 95% CI 1.14, 15.23; p = 0.04). Significance: We have identified EEG biomarkers that differentiate NMDAR AIE from other subtypes. We have also demonstrated EEG biomarkers that are associated with poor functional outcomes.
AB - Objective: To evaluate the utility of electroencephalography (EEG) changes as diagnostic and prognostic biomarkers in acute autoimmune encephalitis (AIE). Methods: One hundred and thirty-one patients with AIE were recruited retrospectively across 7 hospitals. Clinical data were collected during admission and at 12 months. EEGs were reviewed using a standard reporting proforma. Associations between EEG biomarkers, AIE subtypes, and clinical outcomes were assessed using logistic regression modeling. Results: Presence of superimposed fast activity (OR 34.33; 95% CI 3.90, 4527.27; p < 0.001), fluctuating EEG abnormality (OR 6.60; 95% CI 1.60, 37.59; p = 0.008), and hemispheric focality (OR 28.48; 95% CI 3.14, 3773.14; p < 0.001) were significantly more common in N-methyl-D-aspartate receptor (NMDAR) antibody-associated patients with AIE compared to other AIE subtypes. Abnormal background rhythm was associated with a poor mRS (modified Rankin score) at discharge (OR 0.29; 95% CI 0.10, 0.75; p = 0.01) and improvement in mRS at 12 months compared with admission mRS (3.72; 95% CI 1.14, 15.23; p = 0.04). Significance: We have identified EEG biomarkers that differentiate NMDAR AIE from other subtypes. We have also demonstrated EEG biomarkers that are associated with poor functional outcomes.
KW - Autoimmune encephalitis
KW - Biomarker
KW - EEG
KW - LGI-1
KW - NMDA
UR - http://www.scopus.com/inward/record.url?scp=85123595205&partnerID=8YFLogxK
U2 - 10.1016/j.yebeh.2022.108571
DO - 10.1016/j.yebeh.2022.108571
M3 - Article
C2 - 35101840
AN - SCOPUS:85123595205
SN - 1525-5050
VL - 128
JO - Epilepsy & Behavior
JF - Epilepsy & Behavior
M1 - 108571
ER -