Perfusion 123IMP-SPECT shows reversible abnormalities in GABAB receptor antibody associated encephalitis with normal MRI

Kouichi Ohta, Morinobu Seki, Josep Dalmau, Yukito Shinohara

Research output: Contribution to journalArticle

9 Citations (Scopus)

Abstract

A new subtype of autoimmune encephalitis associated with antibodies against GABAB receptor was recently identified. Although immune-mediated functional abnormalities are suggested for the pathogenesis, functional brain imaging such as perfusion SPECT has not been documented. A 62-year-old woman with anti-GABAB receptor associated encephalitis underwent 123I-IMP SPECT in the beginning and after methylprednisolone pulse therapy. Three-dimensional stereotactic surface projection analysis was used to evaluate the cortical distribution of perfusion abnormality. The patient presented with clinical features of subacute limbic encephalitis. Antibodies to GABAB receptor were identified in her serum and cerebrospinal fluid (CSF), but no tumor was detected. Despite normal magnetic resonance imaging (MRI) findings, the first SPECT revealed hypoperfusion of the frontal, parietal and medial temporal lobes, as well as thalamus, and cerebellum. These areas are known to contain high levels of GABAB receptors. In contrast, the SPECT revealed hyperperfusion in the motor strip and left temporal lobe, which are areas related to some of the patient's symptoms, including seizures, orolingual dyskinesia, and Wernicke aphasia. After treatment with pulses of methylprednisolone, the neuropsychiatric symptoms resolved and the SPECT findings showed substantial improvement in most of these regions. In conclusion, the findings suggest that immunotherapy improved the cortical dysfunction mediated by GABAB receptor antibodies.

Original languageEnglish
Pages (from-to)70-72
Number of pages3
JournalBrain and Behavior
Volume1
Issue number2
DOIs
Publication statusPublished - 2011 Nov

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Encephalitis
Single-Photon Emission-Computed Tomography
Perfusion
Magnetic Resonance Imaging
Antibodies
Methylprednisolone
Temporal Lobe
Limbic Encephalitis
Wernicke Aphasia
Inosine Monophosphate
Functional Neuroimaging
Dyskinesias
Motor Cortex
Thalamus
Immunotherapy
Cerebellum
Cerebrospinal Fluid
Seizures
Therapeutics
Serum

Keywords

  • Autoimmune
  • Cerebral cortex
  • Cerebral perfusion
  • Gaba
  • Limbic encephalitis
  • Spect

ASJC Scopus subject areas

  • Behavioral Neuroscience

Cite this

Perfusion 123IMP-SPECT shows reversible abnormalities in GABAB receptor antibody associated encephalitis with normal MRI. / Ohta, Kouichi; Seki, Morinobu; Dalmau, Josep; Shinohara, Yukito.

In: Brain and Behavior, Vol. 1, No. 2, 11.2011, p. 70-72.

Research output: Contribution to journalArticle

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