Morphometric MRI findings in patients with suspected autoimmune psychosis spectrum syndromes and association with EEG slowing, CSF changes, and psychometric/neuropsychological findings

Introduction Patients with autoimmune encephalitis – who often have accompanying psychiatric symptoms – frequently have electroencephalography (EEG) changes and normal conventional magnetic resonance imaging (MRI) findings. The aim of this paper was to analyze automated EEG and morphometric MRI findings in psychiatric patients with suspected autoimmune psychosis (AP) spectrum syndromes versus controls and the correlation of MRI measures with EEG, cerebrospinal fluid (CSF), and psychometric/neuropsychological findings. Participants and methods In total, forty patients were included. Suspected AP spectrum syndromes were defined broadly based on the autoimmune psychiatric syndrome concept. All patients showed signs of an autoimmune process. That is, upon further diagnostic testing, they tested at least positive for well-characterized neuronal antibodies, novel central nervous system antibodies, or well-characterized systemic antibodies with brain involvement. For EEG, thirty-seven matched patient-control pairs, and for structural MRI, thirty-five patients and matched controls, were available. EEG analysis for intermittent rhythmic delta/theta activity (IRDA/IRTA) was performed using independent component analysis. MRI scans were analyzed using FreeSurfer (7.2) for the subcortical measures and CAT12 for cortical thickness and global volumes. Results Patients did not show significantly increased IRDA/IRTA rates. Regarding brain volumes, there was a significant decrease in grey matter volume/total intracranial volume (TIV) (p=0.027) and a significant increase in CSF/TIV (p=0.027), which remained significant after correction for multiple comparisons. Further differences with lower white matter volume/TIV, reduced cortical thickness in the left parahippocampal and transversotemporal gyri and an increase in the volume of the left lateral ventricle of patients did not remain significant after correcting for multiple testing. White blood cell counts in the CSF of the whole patient group correlated positively with increased hippocampal volumes. Brain volumes did not correlate with psychometric scales, but with several neuropsychological scores. Discussion Autoantibody-associated suspected AP spectrum syndromes seem to be associated with slight global grey matter volume reductions and secondary increased CSF volumes. Associations between hippocampal volume increases and inflammatory CSF markers could, in contrast, reflect edematous swelling within the limbic system. Further multimodal imaging studies of more homogeneous AP groups might be promising to detect morphometric correlates.