Early Gray Matter Volume Changes in Pediatric Anti-NMDA Receptor Encephalitis: A Voxel-Based Morphometry Analysis.

Authors

Pradeep Javarayee, Daniel Ackom, Janine Taitt-Tap, Alyssa Jobe, Ricardo Vega, Brian D Schmit, Lileth Mondok, Scott A Beardsley

Published in

Journal of child neurology. Pages 8830738261469349. Jul 28, 2026. Epub Jul 28, 2026.

Abstract

IntroductionPediatric anti-N-methyl-d-aspartate (anti-NMDAR) encephalitis often shows normal or nonspecific findings on conventional magnetic resonance imaging (MRI) at clinical review despite substantial neurologic and psychiatric morbidity. Although adult neuroimaging studies suggest widespread structural brain involvement, comparable pediatric data remain limited.ObjectiveTo characterize regional gray matter volume (GMV) abnormalities in pediatric anti-NMDAR encephalitis using whole-brain voxel-based morphometry (VBM) and examine associations between GMV and clinical markers of disease burden and outcome.MethodsWe performed a retrospective cross-sectional study of 12 pediatric patients with anti-NMDAR encephalitis and 36 age- and sex-matched healthy controls. Pretreatment structural MRI was analyzed using whole-brain VBM (SPM25 with DARTEL normalization). Voxel-wise group comparisons were adjusted for age, sex, scanner batch and total intracranial volume, with cluster-level family-wise error correction at P < .05. Mean GMV from significant clusters was correlated with symptom-onset-to-MRI interval, cerebrospinal fluid white blood cell count, and 1-year modified Rankin Scale (mRS) outcome.ResultsPatients showed significant regional GMV reductions vs controls, with the largest cluster in the left calcarine fissure and surrounding cortex. Additional reductions involved the left precentral gyrus, left fusiform gyrus, left middle frontal gyrus, right medial orbital/superior frontal gyrus, and right postcentral gyrus. Symptom-onset-to-MRI interval was not associated with regional GMV. Left middle frontal gyrus GMV correlated with cerebrospinal fluid white blood cell count and worse 1-year mRS, although these associations may have been influenced by outliers.ConclusionsVBM identified early regional GMV abnormalities on pretreatment MRI in children with anti-NMDAR encephalitis. These findings are hypothesis-generating and require validation in larger prospective cohorts.

PMID:
42517738
Bibliographic data and abstract were imported from PubMed on 28 Jul 2026.

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