Initial EEG Findings Predict Executive Functioning in Children with Anti-n-methyl-d-aspartate Receptor Encephalitis (NMDAR)
Abstract number :
1.362
Submission category :
11. Behavior/Neuropsychology/Language / 11B. Pediatrics
Year :
2022
Submission ID :
2204900
Source :
www.aesnet.org
Presentation date :
12/3/2022 12:00:00 PM
Published date :
Nov 22, 2022, 05:27 AM
Authors :
Ilana Kahn, MD – Children's National Hospital; Alyssa Beth Doslea, M.S. – Clinical Research Coordinator, Neurology, Children's National Hospital; Melissa Fleming, M.D. – Physician, Physical Medicine and Rehabilitation, Children's National Hospital; Claire Semerjian, PsyD – Neuropsychologist, Neuropsychology, Children's National Hospital; William Suslovic, B.S. – Research Assistant, Neurology, Children's National Hospital; Archana Pasupuleti, MD - Children's National Hospital; Elizabeth Wells, M.D. – Vice President, Neuroscience and Behavioral Medicine Center, Neurology, Children's National Hospital; Leigh Sepeta, PhD – Neuropsychologist, Neuropsychology, Children's National Hospital
Rationale: Executive functioning (EF) and memory deficits are primary cognitive concerns following anti-N-methyl-d-aspartate receptor encephalitis (NMDAR) in adults and children, although predictors of cognitive outcomes remain poorly understood. Delay in treatment is predictive of worse outcomes for adults (Finke et al. 2012), but this has not been reported with children (deBruijn et al., 2018). Tailor et al. (2013) studied children with encephalitis and found that seizures at presentation were related to worse cognitive outcome after inpatient rehabilitation implicating the importance of seizures in this population. We aim to fill this gap by investigating predictors of memory and EF in children with NMDAR based on EEG characteristics at presentation.
Methods: We retrospectively identified 12 pediatric patients (mean age=11.3, SD=3.4) with NMDAR who underwent neuropsychological evaluation including measures of memory and EF (mean time since diagnosis=15.2 months). Linear regression models examined several predictors of outcome focusing on initial EEG findings. Abnormal EEG findings at presentation were characterized as focal or generalized slowing, slow Posterior Basic Rhythm (PBR), poor organization, epileptiform discharges and/or abnormal sleep.
Results: One-fifth of parents reported overall elevated everyday EF concerns, with one-third showing specific concerns related to emotional and behavioral EF regulation. Mean scores were broadly average across objective memory and EF measures. The first EEG at the time of symptom presentation was reported abnormal in 10 of the 12 patients (83%). All 10 abnormal EEGs showed focal or generalized slowing. An additional 6/10 of the abnormal EEGs also showed a slow PBR. On parent-reported measures, EEG slowing predicted emotional regulation (BRIEF2- ERI), accounting for 44% of the variance (p=03). A slow PBR predicted behavioral (BRIEF-BRI) and cognitive regulation (BRIEF2-CRI) accounting for 37% (p=.05) and 43.7% (p = .04) of variance respectively. A slow PBR predicted overall EF concerns (BRIEF-GEC), accounting for 43% of the variance (p= 0.04), while EEG slowing only predicted overall EF at the trend level. Slow PBR also predicted ADHD rating scales reported by parents, accounting for 51% of variance (p=0.03). Objective EF measures approached but did not reach statistical significance with any EEG abnormalities. No variables predicted memory performance.
Conclusions: Focal or generalized slowing and a slow PBR on EEG at the time of symptom presentation is helpful in predicting EF outcomes in children with NMDAR, while epileptiform activity at presentation was not. A slow PBR also predicted parent ratings of attention concerns. Further study with additional patients will be important to determine its utility in informing prognosis.
Funding: None
Behavior