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Objective:To investigate the abnormal changes of the nodal centrality of the whole-brain network in patients with narcolepsy type 1 (NT1) through the degree centrality (DC) technique of resting-state magnetic resonance and the predictive value for NT1.Methods:From September 2019 to November 2021, 18 NT1 patients who were first diagnosed and never accepted managements and 18 age-, sex-matched healthy controls recruited by advertisement in the Second Affiliated Hospital of Nanchang University were required for resting-state functional magnetic resonance imaging scans and clinical scale assessment, including Epworth Sleepiness Scale (ESS), Self-rating Anxiety Scale, Self-rating Depression Scale, Pittsburgh Sleep Quality Index, Insomnia Severity Scale and Multidimensional Fatigue Inventory-20 (MFI-20). The differences in DC values between the NT1 patients and healthy controls were analyzed using the DC method. Then, the correlation between DC values in differential brain regions and clinical characteristics of NT1 was explored through Pearson correlation analysis. The receiver operating characteristic (ROC) curve analysis was used to evaluate the predictive value of the DC values in the differential brain regions for NT1 patients.Results:Compared with the healthy controls, the DC value of the right superior temporal gyrus was increased, while the DC values of the bilateral middle frontal gyrus and the right precuneus were decreased in the NT1 patients (all P<0.05, Gaussian random-field correction). The DC value of the right superior temporal gyrus in the NT1 patients was positively correlated with the ESS score ( r=0.82, P<0.001) and MFI-20 score ( r=0.48, P=0.040). The DC value of the right middle frontal gyrus was positively correlated with the disease course ( r=0.51, P=0.032). The ROC curve showed that the area under the curve of NT1 predicted by the DC value of the right superior temporal gyrus was 0.95. And the areas under the curve of non-NT1 predicted by the DC values of the left middle frontal gyrus, right middle frontal gyrus, and right precuneus were 0.86, 0.84 and 0.87, respectively. Conclusions:NT1 patients have abnormal resting-state DC in the default network, executive network core brain regions, and superior temporal gyrus. And the DC value in the right superior temporal gyrus may be a potential biomarker of NT1 patients.
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Anti-neurexin-3α antibody-associated encephalitis is rare in clinical practice. It often has a history of pre-infection. It is characterized by abnormal mental behavior, seizures, decreased consciousness, cognitive and sleep disorders, movement disorder, central hypoventilation and autonomic nervous dysfunction. Among them, dyskinesias are mainly involuntary movements of the mouth, face and limbs, dystonia, myoclonic seizures and other manifestations of increased movement. Parkinson′s symptoms manifested as decreased movement are rarely reported. A encephalitis patient with positive anti-neurexin-3α antibody is reported, who is a young female, mainly with parkinsonism such as slow movement, unsteady walking, difficulty in starting and turning around, and inability to hold things in both upper limbs, accompanied by abnormal mental behavior and cognitive dysfunction. After treatment with methylprednisolone and intravenous immunoglobulin, the prognosis is good.
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Autoimmune encephalitis is a group of inflammatory diseases related to autoantibodies that affect the central nervous system. Early diagnosis of patients with autoimmune encephalitis has certain difficulties, because the clinical manifestations caused by different types of autoantibodies can be non-specific, and the presence of multiple autoantibodies can cause variation and superposition of clinical manifestations. The article reported a case of autoimmune encephalitis patients with double positive anti-N-methyl-D-aspartate receptor and dipeptidyl-peptidase-like protein-6 antibodies, and reviewed relevant literature for clinical reference.