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Abunada M, Nierobisch N, Ludovichetti R, Simmen C, Terziev R, Togni C, Michels L, Kulcsar Z, Hainc N. Autoimmune encephalitis: Early and late findings on serial MR imaging and correlation to treatment timepoints. Eur J Radiol Open 2024; 12:100552. [PMID: 38327544 PMCID: PMC10847996 DOI: 10.1016/j.ejro.2024.100552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 01/26/2024] [Accepted: 01/29/2024] [Indexed: 02/09/2024] Open
Abstract
Introduction MRI is negative in a large percentage of autoimmune encephalitis cases or lacks findings specific to an antibody. Even rarer is literature correlating the evolution of imaging findings with treatment timepoints. We aim to characterize imaging findings in autoimmune encephalitis at presentation and on follow up correlated with treatment timepoints for this rare disease. Methods A full-text radiological information system search was performed for "autoimmune encephalitis" between January 2012 and June 2022. Patients with laboratory-identified autoantibodies were included. MRI findings were assessed in correlation to treatment timepoints by two readers in consensus. For statistical analysis, cell-surface vs intracellular antibody groups were assessed for the presence of early limbic, early extralimbic, late limbic, and late extralimbic findings using the χ2 test. Results Thirty-seven patients (female n = 18, median age 58.8 years; range 25.7 to 82.7 years) with 15 different autoantibodies were included in the study. Twenty-three (62%) patients were MRI-negative at time of presentation; 5 of these developed MRI findings on short-term follow up. Of the 19 patients with early MRI findings, 9 (47%) demonstrated improvement upon treatment initiation (7/9 cell-surface group). There was a significant difference (p = 0.046) between the MRI spectrum of cell-surface vs intracellular antibody syndromes as cell-surface antibody syndromes demonstrated more early classic findings of limbic encephalitis and intracellular antibody syndromes demonstrated more late extralimbic abnormalities. Conclusion MRI can be used to help narrow the differential diagnosis in autoimmune encephalitis and can be used as a monitoring tool for certain subtypes of this rare disease.
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Affiliation(s)
- Mahmoud Abunada
- Department of Neuroradiology, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Switzerland
| | - Nathalie Nierobisch
- Department of Neuroradiology, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Switzerland
| | - Riccardo Ludovichetti
- Department of Neuroradiology, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Switzerland
| | - Cyril Simmen
- Department of Neurology, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Switzerland
| | - Robert Terziev
- Department of Neurology, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Switzerland
| | - Claudio Togni
- Department of Neurology, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Switzerland
| | - Lars Michels
- Department of Neuroradiology, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Switzerland
| | - Zsolt Kulcsar
- Department of Neuroradiology, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Switzerland
| | - Nicolin Hainc
- Department of Neuroradiology, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Switzerland
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Sinka L, Abraira L, Imbach LL, Zieglgänsberger D, Santamarina E, Álvarez-Sabín J, Ferreira-Atuesta C, Katan M, Scherrer N, Bicciato G, Terziev R, Simmen C, Schubert KM, Elshahabi A, Baumann CR, Döhler N, Erdélyi-Canavese B, Felbecker A, Siebel P, Winklehner M, von Oertzen TJ, Wagner JN, Gigli GL, Serafini A, Nilo A, Janes F, Merlino G, Valente M, Zafra-Sierra MP, Bayona-Ortiz H, Conrad J, Evers S, Lochner P, Roell F, Brigo F, Bentes C, Peralta AR, Pinho e Melo T, Keezer MR, Duncan JS, Sander JW, Tettenborn B, Koepp MJ, Galovic M. Association of Mortality and Risk of Epilepsy With Type of Acute Symptomatic Seizure After Ischemic Stroke and an Updated Prognostic Model. JAMA Neurol 2023; 80:605-613. [PMID: 37036702 PMCID: PMC10087089 DOI: 10.1001/jamaneurol.2023.0611] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2022] [Accepted: 12/16/2022] [Indexed: 04/11/2023]
Abstract
Importance Acute symptomatic seizures occurring within 7 days after ischemic stroke may be associated with an increased mortality and risk of epilepsy. It is unknown whether the type of acute symptomatic seizure influences this risk. Objective To compare mortality and risk of epilepsy following different types of acute symptomatic seizures. Design, Setting, and Participants This cohort study analyzed data acquired from 2002 to 2019 from 9 tertiary referral centers. The derivation cohort included adults from 7 cohorts and 2 case-control studies with neuroimaging-confirmed ischemic stroke and without a history of seizures. Replication in 3 separate cohorts included adults with acute symptomatic status epilepticus after neuroimaging-confirmed ischemic stroke. The final data analysis was performed in July 2022. Exposures Type of acute symptomatic seizure. Main Outcomes and Measures All-cause mortality and epilepsy (at least 1 unprovoked seizure presenting >7 days after stroke). Results A total of 4552 adults were included in the derivation cohort (2547 male participants [56%]; 2005 female [44%]; median age, 73 years [IQR, 62-81]). Acute symptomatic seizures occurred in 226 individuals (5%), of whom 8 (0.2%) presented with status epilepticus. In patients with acute symptomatic status epilepticus, 10-year mortality was 79% compared with 30% in those with short acute symptomatic seizures and 11% in those without seizures. The 10-year risk of epilepsy in stroke survivors with acute symptomatic status epilepticus was 81%, compared with 40% in survivors with short acute symptomatic seizures and 13% in survivors without seizures. In a replication cohort of 39 individuals with acute symptomatic status epilepticus after ischemic stroke (24 female; median age, 78 years), the 10-year risk of mortality and epilepsy was 76% and 88%, respectively. We updated a previously described prognostic model (SeLECT 2.0) with the type of acute symptomatic seizures as a covariate. SeLECT 2.0 successfully captured cases at high risk of poststroke epilepsy. Conclusions and Relevance In this study, individuals with stroke and acute symptomatic seizures presenting as status epilepticus had a higher mortality and risk of epilepsy compared with those with short acute symptomatic seizures or no seizures. The SeLECT 2.0 prognostic model adequately reflected the risk of epilepsy in high-risk cases and may inform decisions on the continuation of antiseizure medication treatment and the methods and frequency of follow-up.
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Affiliation(s)
- Lucia Sinka
- Department of Neurology, Clinical Neuroscience Center, University Hospital and University of Zurich, Zurich, Switzerland
| | - Laura Abraira
- Epilepsy Unit, Department of Neurology, Vall d’Hebron Hospital Universitari, Barcelona, and Universitat Autonoma de Barcelona, Bellaterra, Spain
| | | | | | - Estevo Santamarina
- Epilepsy Unit, Department of Neurology, Vall d’Hebron Hospital Universitari, Barcelona, and Universitat Autonoma de Barcelona, Bellaterra, Spain
| | - José Álvarez-Sabín
- Epilepsy Unit, Department of Neurology, Vall d’Hebron Hospital Universitari, Barcelona, and Universitat Autonoma de Barcelona, Bellaterra, Spain
| | - Carolina Ferreira-Atuesta
- Department of Clinical & Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, United Kingdom
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, New York
- Chalfont Centre for Epilepsy, Chalfont St Peter, United Kingdom
| | - Mira Katan
- Department of Neurology, Clinical Neuroscience Center, University Hospital and University of Zurich, Zurich, Switzerland
- Department of Neurology, University Hospital and University of Basel, Basel, Switzerland
| | - Natalie Scherrer
- Department of Neurology, Clinical Neuroscience Center, University Hospital and University of Zurich, Zurich, Switzerland
| | - Giulio Bicciato
- Department of Neurology, Clinical Neuroscience Center, University Hospital and University of Zurich, Zurich, Switzerland
| | - Robert Terziev
- Department of Neurology, Clinical Neuroscience Center, University Hospital and University of Zurich, Zurich, Switzerland
| | - Cyril Simmen
- Department of Neurology, Clinical Neuroscience Center, University Hospital and University of Zurich, Zurich, Switzerland
| | - Kai Michael Schubert
- Department of Neurology, Clinical Neuroscience Center, University Hospital and University of Zurich, Zurich, Switzerland
| | - Adham Elshahabi
- Department of Neurology, Clinical Neuroscience Center, University Hospital and University of Zurich, Zurich, Switzerland
| | - Christian R. Baumann
- Department of Neurology, Clinical Neuroscience Center, University Hospital and University of Zurich, Zurich, Switzerland
| | - Nico Döhler
- Department of Neurology, Kantonsspital St. Gallen, St Gallen, Switzerland
- Specialist Clinic for Neurorehabilitation, Kliniken Beelitz, Beelitz-Heilstätten, Germany
| | | | - Ansgar Felbecker
- Department of Neurology, Kantonsspital St. Gallen, St Gallen, Switzerland
| | - Philip Siebel
- Department of Neurology, Kantonsspital St. Gallen, St Gallen, Switzerland
| | - Michael Winklehner
- Department of Neurology 1, Kepler Universitätsklinikum, Neuromed Campus, Linz, Austria
- Division of Neuropathology and Neurochemistry, Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Tim J. von Oertzen
- Department of Neurology 1, Kepler Universitätsklinikum, Neuromed Campus, Linz, Austria
| | - Judith N. Wagner
- Department of Neurology 1, Kepler Universitätsklinikum, Neuromed Campus, Linz, Austria
| | - Gian Luigi Gigli
- Department of Medicine, University of Udine and Clinical Neurology, Udine University Hospital, Udine, Italy
| | - Anna Serafini
- Department of Medicine, University of Udine and Clinical Neurology, Udine University Hospital, Udine, Italy
| | - Annacarmen Nilo
- Department of Medicine, University of Udine and Clinical Neurology, Udine University Hospital, Udine, Italy
| | - Francesco Janes
- Department of Medicine, University of Udine and Clinical Neurology, Udine University Hospital, Udine, Italy
| | - Giovanni Merlino
- Department of Medicine, University of Udine and Clinical Neurology, Udine University Hospital, Udine, Italy
| | - Mariarosaria Valente
- Department of Medicine, University of Udine and Clinical Neurology, Udine University Hospital, Udine, Italy
| | - María Paula Zafra-Sierra
- Department of Neurology, Fundación Santa Fe de Bogotá, Universidad de Los Andes, Universidad del Bosque, Bogotá, Colombia
| | - Hernan Bayona-Ortiz
- Department of Neurology, Fundación Santa Fe de Bogotá, Universidad de Los Andes, Universidad del Bosque, Bogotá, Colombia
| | - Julian Conrad
- Department of Neurology, University of Muenster, Muenster, Germany
- Department of Neurology and German Center for Vertigo and Balance Disorders-IFB-LMU, Ludwig Maximilians University of Munich, Munich, Germany
| | - Stefan Evers
- Department of Neurology, University of Muenster, Muenster, Germany
- Department of Neurology, Krankenhaus Lindenbrunn, Coppenbrügge, Germany
| | - Piergiorgio Lochner
- Department of Neurology, Saarland University Medical Center, Homburg, Germany
| | - Frauke Roell
- Department of Neurology, Saarland University Medical Center, Homburg, Germany
| | - Francesco Brigo
- Department of Neurology, Hospital of Merano (SABES-ASDAA), Merano-Meran, Italy
| | - Carla Bentes
- Department of Neurosciences and Mental Health (Neurology), Hospital de Santa Maria-CHLN, Centro de Estudos Egas Moniz, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
| | - Ana Rita Peralta
- Department of Neurosciences and Mental Health (Neurology), Hospital de Santa Maria-CHLN, Centro de Estudos Egas Moniz, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
| | - Teresa Pinho e Melo
- Department of Neurosciences and Mental Health (Neurology), Hospital de Santa Maria-CHLN, Centro de Estudos Egas Moniz, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
| | - Mark R. Keezer
- Stichting Epilepsie Instellingen Nederland (SEIN), Heemstede, the Netherlands
- Centre Hospitalier de l’Université de Montréal, Montreal, Quebec, Canada
| | - John S. Duncan
- Department of Clinical & Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, United Kingdom
- Chalfont Centre for Epilepsy, Chalfont St Peter, United Kingdom
| | - Josemir W. Sander
- Department of Clinical & Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, United Kingdom
- Chalfont Centre for Epilepsy, Chalfont St Peter, United Kingdom
- Stichting Epilepsie Instellingen Nederland (SEIN), Heemstede, the Netherlands
| | - Barbara Tettenborn
- Department of Neurology, Kantonsspital St. Gallen, St Gallen, Switzerland
| | - Matthias J. Koepp
- Department of Clinical & Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, United Kingdom
- Chalfont Centre for Epilepsy, Chalfont St Peter, United Kingdom
| | - Marian Galovic
- Department of Neurology, Clinical Neuroscience Center, University Hospital and University of Zurich, Zurich, Switzerland
- Department of Clinical & Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, United Kingdom
- Chalfont Centre for Epilepsy, Chalfont St Peter, United Kingdom
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Belkin M, Wussler D, Michou E, Strebel I, Kozhuharov N, Sabti Z, Nowak A, Shrestha S, Lopez-Ayala P, Albus MB, Danier I, Simmen C, Diebold M, Breidthardt T, Mueller C. Prognostic value of self-reported subjective exercise capacity in patients with acute dyspnea. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Quantitative assessment of self-reported exercise capacity as provided by the Duke Activity Status Index (DASI) is a validated measure of exercise capacity in stable ambulatory patients.
Objectives
This study aimedto test whether the quantification of self-reported exercise capacityusing the DASI may aid physicians in the risk stratification of patients presenting with acute dyspnea to the emergency department (ED).
Methods
Basics in Acute Shortness of Breath EvaLuation (BASEL V) was a prospective cohort study recruiting dyspneic patients at the ED. The prognostic value and accuracy of theDASI assessed shortly after presentation were quantified using Cox regression analyses and the Area under the curve (AUC).
Results
Among 1019 patients eligible for this analysis 529 (51.9%) had an adjudicated final diagnosis of acute heart failure, 75 (7.4%) and 297 (29.1%) patients died within 90 and 720 days after presentation. Unadjusted hazard ratios (HR) and multivariable adjusted hazard ratios (aHR) for 90-day and 720-day mortality increased continuously from the fourth (best self-reported exercise capacity) to the first DASI-quartile (worst self-reported exercise capacity). For 720-day mortality in the first quartile theHR was 9.1 (95%-CI 5.5–14.9) (aHR 6.1 [95%-CI 3.7–10.1]), in the second quartile 6.4 (95%-CI 3.9–10.6) (aHR 4.4 [95%-CI 2.6–7.3]), while in the third quartile the HR was 3.2 (95%-CI 1.9–5.5) (aHR 2.4 [95%-CI 1.4–4.0]). The prognostic accuracy of the DASI was moderate-to-high and higher than that of B-type natriuretic peptide (BNP) and NT-proBNP (N-terminal pro-BNP) concentrations, e.g. for 720-day mortality prediction AUC 0.70 versus 0.64, p=0.020; 0.72 versus 0.68, p=0.074.
Conclusions
Quantification of self-reported subjective exercise capacityusing the DASI provides moderate-to-high prognostic accuracy in patients presenting with acute dyspnea to the ED and may aid physicians in further risk stratification.
Funding Acknowledgement
Type of funding sources: Public grant(s) – EU funding. Main funding source(s): European Union, the Swiss National Science Foundation. Duke Activity Status Index
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Affiliation(s)
- M Belkin
- University Hospital Basel, Basel, Switzerland
| | - D Wussler
- University Hospital Basel, Basel, Switzerland
| | - E Michou
- University Hospital Basel, Basel, Switzerland
| | - I Strebel
- University Hospital Basel, Basel, Switzerland
| | | | - Z Sabti
- University Hospital Basel, Basel, Switzerland
| | - A Nowak
- University Hospital Basel, Basel, Switzerland
| | - S Shrestha
- University Hospital Basel, Basel, Switzerland
| | | | - M B Albus
- University Hospital Basel, Basel, Switzerland
| | - I Danier
- University Hospital Basel, Basel, Switzerland
| | - C Simmen
- University Hospital Basel, Basel, Switzerland
| | - M Diebold
- University Hospital Basel, Basel, Switzerland
| | | | - C Mueller
- University Hospital Basel, Basel, Switzerland
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