Overlapping Diagnoses and the Advancement of MS Detection in NMDARE: Joseph Kuchling, MD

WATCH TIME: 6 minutes

"What we found was the [central vein sign], which we commonly see in patients with [multiple sclerosis] but not in other diseases. This sign, along with paramagnetic rim lesions, helped us conclude that these lesions originated from [the disease]."

While research indicates that some patients with anti-N-methyl-D-aspartate receptor encephalitis (NMDARE) often exhibit co-occurring clinical symptoms and T2-hyperintense MRI lesions consistent with multiple sclerosis (MS), little evidence exists regarding the specific MRI features of this overlap syndrome. A recent study conducted by lead author Joseph Kuchling, MD, and colleagues, showed that overlap with MS frequently occurred in patients with NMDARE. These results suggest a potential pathophysiological connection between both entities implicating particular diagnostic and therapeutic awareness in the management of MS and NMDARE.

Presented at the 2024 European Committee for Treatment and Research in Multiple Sclerosis (ECTRIMS) Congress, held September 18-20, in Copenhagen, Denmark, investigators compared neuroimaging data of patients with the overlapping conditions and “stand-alone” patients who had NMDARE, both from centers in the nation-wide GErman NEtwork for Research of AuToimmune Encephalitis network. Additional findings from the presented study revealed that patients with overlap NMDARE-MS experienced more NMDARE-atypical symptoms and were characterized by an MS-typical conventional MRI lesion pattern, rapid lesion accumulation, and an MS-specific 7T-MRI lesion morphology with central vein sign.

At the 2024 ECTRIMS Congress, Kuchling, a postdoctoral research assistant at Charité University Berlin, sat down with NeurologyLive^® to discuss how the integration of advanced MRI techniques might, such as 7-Tesla imaging, may reshape the diagnostic approach for patients presenting with both encephalitis and suspected MS lesions. He also spoke about the implications that earlier MS diagnosis using the new McDonald criteria could have on long-term patient outcomes, particularly in cases with overlapping NMDARE and MS. Moreover, Kuchling spoke about the challenges that clinicians foresee when transitioning from the previous McDonald criteria to the revised one in real-world diagnostic settings.

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REFERENCES
1. Kuchling J, Penner L, Fernandez Ceballos R, et al. NMDA Receptor Encephalitis and Multiple Sclerosis Overlap Syndrome - Part I: Clinical Findings and MRI Characteristics. Presented at ECTRIMS Congress; September 18-20, 2024; Copenhagen, Denmark. Scientific Session 1: New diagnostic criteria. Abstract 2310.