MRI Findings in Autoimmune Voltage-Gated Potassium Channel Complex Encephalitis with Seizures: One Potential Etiology for Mesial Temporal Sclerosis

Fellows’ Journal Club

January 2014

(3 of 3)

Voltage-gated potassium channel complex encephalitis is a common form of autoimmune encephalitis presenting with intractable seizures that may respond to immunotherapy. These authors reviewed the imaging findings in 42 such patients and the most common abnormalities noted were enlargement, T2 hyperintensity, contrast enhancement, and restricted diffusion in the mesial temporal lobes with subsequent development of hippocampal atrophy. Because the disease can be confirmed easily by the presence of voltage-gated potassium channel complex antibodies, these imaging findings should prompt serologic testing.

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Abstract

BACKGROUND AND PURPOSE
Autoimmune voltage-gated potassium channel complex encephalitis is a common form of autoimmune encephalitis. Patients with seizures due to this form of encephalitis commonly have medically intractable epilepsy and may require immunotherapy to control seizures. It is important that radiologists recognize imaging characteristics of this type of autoimmune encephalitis and suggest it in the differential diagnosis because this seizure etiology is likely under-recognized. Our purpose was to characterize MR imaging findings in this patient population.

MATERIALS AND METHODS
MR imaging in 42 retrospectively identified patients (22 males; median age, 56 years; age range, 8–79 years) with seizures and voltage-gated potassium channel complex autoantibody seropositivity was evaluated for mesial and extratemporal swelling and/or atrophy, T2 hyperintensity, restricted diffusion, and enhancement. Statistical analysis was performed.

RESULTS
Thirty-three of 42 patients (78.6%) demonstrated enlargement and T2 hyperintensity of mesial temporal lobe structures at some time point. Mesial temporal sclerosis was commonly identified (16/33, 48.5%) at follow-up imaging. Six of 9 patients (66.7%, P = .11) initially demonstrating hippocampal enhancement and 8/13 (61.5%, P = .013) showing hippocampal restricted diffusion progressed to mesial temporal sclerosis. Conversely, in 6 of 33 patients, abnormal imaging findings resolved.

CONCLUSIONS
Autoimmune voltage-gated potassium channel complex encephalitis is frequently manifested as enlargement, T2 hyperintensity, enhancement, and restricted diffusion of the mesial temporal lobe structures in the acute phase. Recognition of these typical imaging findings may help prompt serologic diagnosis, preventing unnecessary invasive procedures and facilitating early institution of immunotherapy. Serial MR imaging may demonstrate resolution or progression of radiologic changes, including development of changes involving the contralateral side and frequent development of mesial temporal sclerosis.

Full text

MRI Findings in Autoimmune Voltage-Gated Potassium Channel Complex Encephalitis with Seizures: One Potential Etiology for Mesial Temporal Sclerosis
Mauricio Castillo • Univ of North Carolina

I am Division Chief of Neuroradiology at the University of North Carolina in Chapel Hill. In addition, I am a Professor of Radiology and the current Editor-in-Chief of the American Journal of Neuroradiology. I trained in Diagnostic Radiology at the University of Miami and was a Neuroradiology fellow at Emory University.