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Held NR, Bauer T, Reiter JT, Hoppe C, Keil VCW, Radbruch A, Helmstaedter C, Surges R, Rüber T. Globally altered microstructural properties and network topology in Rasmussen's encephalitis. Brain Commun 2023; 5:fcad290. [PMID: 37953836 PMCID: PMC10638105 DOI: 10.1093/braincomms/fcad290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 10/10/2023] [Accepted: 10/31/2023] [Indexed: 11/14/2023] Open
Abstract
Rasmussen's encephalitis is an immune-mediated brain disorder characterised by progressive unilateral cerebral atrophy, neuroinflammation, drug-resistant seizures and cognitive decline. However, volumetric changes and epileptiform EEG activity were also observed in the contralateral hemisphere, raising questions about the aetiology of contralateral involvement. In this study, we aim to investigate alterations of white matter integrity, structural network topology and network efficiency in Rasmussen's encephalitis using diffusion-tensor imaging. Fourteen individuals with Rasmussen's encephalitis (11 female, median onset 6 years, range 4-22, median disease duration at MRI 5 years, range 0-42) and 20 healthy control subjects were included. All subjects underwent T1-weighted structural and diffusion-tensor imaging. Diffusion-tensor images were analysed using the fixel-based analysis framework included in the MRtrix3 toolbox. Fibre density and cross-section served as a quantitative measure for microstructural white matter integrity. T1-weighted structural images were processed using FreeSurfer, subcortical segmentations and cortical parcellations using the Desikan-Killiany atlas served as nodes in a structural network model, edge weights were determined based on streamline count between pairs of nodes and compared using network-based statistics. Global efficiency was used to quantify network integration on an intrahemispheric level. All metrics were compared cross-sectionally between individuals with Rasmussen's encephalitis and healthy control subjects using sex and age as regressors and within the Rasmussen's encephalitis group using linear regression including age at onset and disease duration as independent variables. Relative to healthy control subjects, individuals with Rasmussen's encephalitis showed significantly (family-wise-error-corrected P < 0.05) lower fibre density and cross-section as well as edge weights in intrahemispheric connections within the ipsilesional hemisphere and in interhemispheric connections. Lower edge weights were noted in the contralesional hemisphere and in interhemispheric connections, with the latter being mainly affected within the first 2 years after disease onset. With longer disease duration, fibre density and cross-section significantly (uncorrected P < 0.01) decreased in both hemispheres. In the contralesional corticospinal tract, fibre density and cross-section significantly (uncorrected P < 0.01) increased with disease duration. Intrahemispheric edge weights (uncorrected P < 0.01) and global efficiency significantly increased with disease duration in both hemispheres (ipsilesional r = 0.74, P = 0.001; contralesional r = 0.67, P = 0.012). Early disease onset was significantly (uncorrected P < 0.01) negatively correlated with lower fibre density and cross-section bilaterally. Our results show that the disease process of Rasmussen's encephalitis is not limited to the cortex of the lesioned hemisphere but should be regarded as a network disease affecting white matter across the entire brain and causing degenerative as well as compensatory changes on a network level.
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Affiliation(s)
- Nina R Held
- Department of Epileptology, University Hospital Bonn, 53127 Bonn, Germany
| | - Tobias Bauer
- Department of Epileptology, University Hospital Bonn, 53127 Bonn, Germany
| | - Johannes T Reiter
- Department of Epileptology, University Hospital Bonn, 53127 Bonn, Germany
| | - Christian Hoppe
- Department of Epileptology, University Hospital Bonn, 53127 Bonn, Germany
| | - Vera C W Keil
- Department of Neuroradiology, University Hospital Bonn, 53127 Bonn, Germany
- Department of Radiology and Nuclear Medicine, Amsterdam UMC Location Vrije Universiteit Amsterdam, 1081 HV Amsterdam, Netherlands
- Amsterdam Neuroscience, Brain Imaging, Amsterdam UMC, 1081 HV Amsterdam, Netherlands
- Cancer Center Amsterdam, Brain Tumor Center Amsterdam, Amsterdam UMC, 1081 HV Amsterdam, Netherlands
| | - Alexander Radbruch
- Department of Neuroradiology, University Hospital Bonn, 53127 Bonn, Germany
| | | | - Rainer Surges
- Department of Epileptology, University Hospital Bonn, 53127 Bonn, Germany
| | - Theodor Rüber
- Department of Epileptology, University Hospital Bonn, 53127 Bonn, Germany
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Carreño M, Martí MJ, Aldecoa I, Painous C, Conde E, Valldeoriola F, Valls-Solé J, Bargalló N, Gil F, Manzanares I, Setoain X, Donaire A, Muñoz E, Roldán P, Boget T, Pintor L, Bailles E, Rumià J. Unilateral pallidal stimulation for disabling dystonia due to Rasmussen's disease. J Neurol Neurosurg Psychiatry 2019; 90:108-110. [PMID: 29986904 DOI: 10.1136/jnnp-2018-318029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Revised: 06/15/2018] [Accepted: 06/18/2018] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To describe an adult patient with Rasmussen's disease with focal dystonia as the most disabling symptom and the good response to unilateral globus pallidus internus (GPi) deep brain stimulation (DBS). METHODS Retrospective review of clinical records and diagnostic tests. RESULTS The patient had displayedmild focal seizures with sensory and motor symptoms on the left arm and hemiface since the age of 22. Ten years later she experienced abrupt onset of focal left dystonia involving mainly the leg. Brain MRI showed progressive right hemisphere atrophy, and 18 fluorodeoxyglucose-positron emission tomography (18FDG-PET) showed right hypometabolism mainly over the frontal and insular regions. Brain biopsy confirmed chronic encephalitis. The dystonia became very severe and made walking extremely difficult. Different treatments including dopaminergic, anticholinergic, immunomodulatory drugs and botulinum toxin were ineffective. Finally the patient was treated with unilateral GPi DBS. Shortly after the onset of the stimulation, the dystonia started to improve. Parameters have been adjusted, and 18 months after surgery the patient is able to walk and run unaided, although a mild left leg dystonia persists. CONCLUSION Rasmussen's disease may be difficult to diagnose in adult patients. Associated movement disorders may be more disabling than seizures. Focal dystonia may be treated successfully with DBS.
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Affiliation(s)
- Mar Carreño
- Epilepsy Unit, Department of Neurology, Hospital Clínic, Barcelona, Spain
| | - Maria José Martí
- Movement Disorder Unit, Department of Neurology, Hospital Clínic, Barcelona, Spain
| | - Ibán Aldecoa
- Department of Pathology, Hospital Clínic, Barcelona, Spain
| | - Celia Painous
- Department of Neurology, Hospital de la Santa Creu I Sant Pau, Barcelona, Spain
| | - Estefanía Conde
- Epilepsy Unit, Department of Neurology, Hospital Clínic, Barcelona, Spain
| | | | - Josep Valls-Solé
- EMG Unit, Department of Neurology, Hospital Clínic, Barcelona, Spain
| | - Núria Bargalló
- Department of Radiology, Hospital Clínic, Barcelona, Spain
| | - Francisco Gil
- Epilepsy Unit, Department of Neurology, Hospital Clínic, Barcelona, Spain
| | - Isabel Manzanares
- Epilepsy Unit, Department of Neurology, Hospital Clínic, Barcelona, Spain
| | - Xavier Setoain
- Department of Nuclear Medicine, Hospital Clínic, Barcelona, Spain
| | - Antonio Donaire
- Epilepsy Unit, Department of Neurology, Hospital Clínic, Barcelona, Spain
| | - Esteban Muñoz
- Movement Disorder Unit, Department of Neurology, Hospital Clínic, Barcelona, Spain
| | - Pedro Roldán
- Functional Neurosurgery Unit, Department of Neurosurgery, Hospital Clínic, Barcelona, Spain
| | - Teresa Boget
- Department of Psychiatry and Psychology, Hospital Clínic, Barcelona, Spain
| | - Luis Pintor
- Department of Psychiatry and Psychology, Hospital Clínic, Barcelona, Spain
| | - Eva Bailles
- Department of Psychiatry and Psychology, Hospital Clínic, Barcelona, Spain
| | - Jordi Rumià
- Functional Neurosurgery Unit, Department of Neurosurgery, Hospital Clínic, Barcelona, Spain
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Baghban A, Malinis M. Ganciclovir and foscarnet dual-therapy for cytomegalovirus encephalitis: A case report and review of the literature. J Neurol Sci 2018; 388:28-36. [PMID: 29627026 DOI: 10.1016/j.jns.2018.02.029] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Revised: 01/15/2018] [Accepted: 02/18/2018] [Indexed: 11/26/2022]
Abstract
Cytomegalovirus (CMV) is a ubiquitous herpesvirus which establishes lifelong latency following primary infection. It is then capable of reactivating in the face of immunosuppression. Encephalitis is a less common, but particularly devastating syndrome associated with CMV. Here, we describe a case of CMV encephalitis in an allogeneic hematopoietic stem cell transplant recipient who received dual antiviral therapy with ganciclovir and foscarnet. The case presentation is followed by a summary of cases reported in the last ten years, with the goal of describing vulnerable patient populations, treatment courses, and outcomes. Finally, the discussion includes a review of the literature, with a focus on diagnostic criteria and the role for dual antiviral therapy in CMV encephalitis.
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Affiliation(s)
- Adam Baghban
- Department of Medicine, Section of Infectious Diseases, Yale University School of Medicine, New Haven, CT, United States.
| | - Maricar Malinis
- Department of Medicine, Section of Infectious Diseases, Yale University School of Medicine, New Haven, CT, United States
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Castellano JF, Meyer JA, Lado FA. A Case Series of Adult-Onset Rasmussen's Encephalitis: Diagnostic and Therapeutic Challenges. Front Neurol 2017; 8:564. [PMID: 29118737 PMCID: PMC5660978 DOI: 10.3389/fneur.2017.00564] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2017] [Accepted: 10/09/2017] [Indexed: 12/22/2022] Open
Abstract
Rasmussen’s encephalitis (RE) is a rare neurologic disorder characterized by progressive cerebral hemiatrophy and medically refractory epilepsy. The majority of current literature on this topic is focused on the pediatric population. In this case series, we will review three cases of adult-onset RE, as defined by fulfillment of the 2005 Bien criteria. The diagnostic challenge of characterizing this rare disease will be highlighted by the extensive serum, CSF, and pathologic sampling in all three patients. MR imaging and EEG data will be examined over time to characterize hallmark findings as well as progression. In addition, we will review the various forms of therapy attempted in these three patients, namely anti-epileptic drug therapy and immunomodulatory therapy. We will also utilize this case series to critically evaluate the broader context of atypical presentations of this disease and the value of current diagnostic criteria.
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Affiliation(s)
| | - Jenny A Meyer
- Saul Korey Department of Neurology, Montefiore Medical Center, Bronx, NY, United States
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Dupont S, Gales A, Sammey S, Vidailhet M, Lambrecq V. Late-onset Rasmussen Encephalitis: A literature appraisal. Autoimmun Rev 2017; 16:803-810. [DOI: 10.1016/j.autrev.2017.05.022] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Accepted: 04/19/2017] [Indexed: 12/20/2022]
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