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Anti-N-Methyl-D-Aspartate Receptor EncephalitisDANCE-AENCT05280600

Developing Advanced Neuroimaging for Clinical Evaluation of Autoimmune Encephalitis

An observational study of Anti-N-Methyl-D-Aspartate Receptor Encephalitis and Autoimmune Encephalitis, run by King's College London at 1 site in United Kingdom.

Unknown status

Status not confirmed. The sponsor has not verified this record for over two years, so it may be out of date.

Official record
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Trial summary

Autoimmune encephalitis is brain inflammation caused by the immune system mistakenly reacting against proteins in the brain. The commonest form is called NMDAR-antibody encephalitis (N-methyl-D-aspartate receptor antibody encephalitis), a rare condition which mainly affects children and young people and causes… Read more about this study

Who is it for?
Ages 8 to 24 yearsHealthy volunteers can take part
What is being tested?
Not applicable - non-interventional study
How many people
75 participants
Where
1 siteUnited Kingdom
Study dates
19 May 2022to 28 Feb 2026
Phase
Observational
Are there results?
None posted in the registry

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 8 to 24 years
  • All sexes
  • Healthy volunteers accepted
  • Child, Adult

Study population: All participants will be recruited in the United Kingdom. NMDAR-antibody encephalitis and antibody-negative autoimmune encephalitis groups: Identified by neurologists/paediatric neurologists in secondary/tertiary healthcare settings, or by self-referral via the Encephalitis Society. Healthy control group: Identified from King's College London volunteer databases, friends and siblings of autoimmune encephalitis cases, or recruited from local schools and colleges.

Who may be able to join

  • NMDAR-antibody encephalitis group:
  • Age 8-24 years at study enrollment.
  • Disease onset in the last 12 months before study enrollment.
  • Meets consensus diagnostic criteria (Graus et al., 2016) for either probable anti-NMDAR encephalitis OR definite anti-NMDAR encephalitis.
  • Antibody-negative autoimmune encephalitis group:
  • Age 8-24 years at study enrollment.
Show all 10Show fewer
  • Disease onset in the last 12 months before study enrollment.
  • Meets consensus diagnostic criteria (Graus et al., 2016) for either autoantibody-negative but probable autoimmune encephalitis OR definite autoimmune limbic encephalitis.
  • Healthy control group:
  • 1. Age 8-24 years at study enrollment.

Who cannot join

  • All participants:
  • 1. Any clear contra-indication for an MRI scan. In particular this would be due to the presence of any implanted devices or metal from previous surgery or accident.
  • Healthy control group:
  • 1. A known neurological or neurodevelopmental disorder.
  • NMDAR-antibody encephalitis and antibody-negative autoimmune encephalitis groups:
  • Alternative more likely cause of neurological symptoms than autoimmune encephalitis, i.e. reasonable exclusion of other diagnoses as per consensus criteria (Graus et al., 2016).
  • Severe movement disorder/uncontrolled epilepsy/dysautonomia.
  • Previous infective encephalitis with major destructive brain lesions.

Trial locations and contacts

1 site in 1 country.

Michael R Eyre, MBBS MRes contact

+44 207 1887188 ext. 56322

michael.eyre@kcl.ac.uk

David W Carmichael, PhD MSci contact

david.carmichael@kcl.ac.uk

United Kingdom1 site, 1 recruiting
  • Guy's and St Thomas' NHS Foundation Trust

    London, Greater London, SE1 7EH

    Michael R Eyre, MBBS MRes, michael.eyre@kcl.ac.uk

    Ming J Lim, MBBS PhD, ming.lim@gstt.nhs.uk

    Recruiting

Other trials in United Kingdom

About this study

Autoimmune encephalitis is brain inflammation caused by the immune system mistakenly reacting against proteins in the brain. The commonest form is called NMDAR-antibody encephalitis (N-methyl-D-aspartate receptor antibody encephalitis), a rare condition which mainly affects children and young people and causes difficulties in memory, thinking and mental health which can have significant long-term impacts on education, employment and quality of life.

In this project we will use advanced magnetic resonance imaging (MRI) to measure changes in the structure, function and chemistry of the brains of children and young people who are in early recovery from NMDAR-antibody encephalitis and other forms of immune-mediated encephalitis. We will investigate if MRI measurements in patients differ from those in healthy people, and if they can help predict patient outcome one year later, assessed by tests of memory, thinking, mental health and functioning in daily life.

Read the detailed description

This study aims to develop non-invasive, in vivo measures of neurobiological dysfunction derived from the overarching hypothesis that dysfunction of inhibitory interneurons alters the cerebral concentrations of gamma-aminobutyric acid (GABA) and glutamate (Glu) and underlies T2 changes and deficient connectivity in functional networks in early recovery from NMDAR-antibody encephalitis. Our ambition is to identify the best potential prognostic biomarkers from these neurometabolite measurements and structural and functional MRI.

Our primary objective is to test the following specific hypotheses in children and young people with NMDAR-antibody encephalitis:

  • Hypothesis 1: GABA is decreased, and Glu increased, on MR spectroscopy of the medial temporal lobe and medial prefrontal cortex in NMDAR-antibody encephalitis.
  • Hypothesis 2: Local GABA and Glu are correlated with (i) resting-state functional MRI (fMRI) based functional connectivity and (ii) parameter map-based microstructural changes. Specifically, we hypothesise that (i) GABA is positively correlated and Glu inversely correlated with functional connectivity, assessed by whole-brain mapping of the default mode network and seed-based analysis of hippocampal-frontal connectivity; and (ii) Glu is positively correlated and GABA inversely correlated with median T2 values within the hippocampus.
  • Hypothesis 3: Local neurometabolites, network measures and microstructural changes predict cognitive, psychiatric and functional outcome at one year. Specifically, we hypothesise that medial temporal Glu, GABA and hippocampal T2 predict memory performance, and prefrontal Glu and GABA predict attention, executive function and fluid intelligence.
Being tested
Not applicable - non-interventional study
Keywords
Magnetic resonance imaging (MRI), Magnetic resonance spectroscopy (MRS), Resting-state functional MRI, Cognition, Ultra-high field MRI
Medical subject headings
Anti-N-Methyl-D-Aspartate Receptor Encephalitis, Autoimmune Diseases of the Nervous System

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Not applicable - non-interventional studyOther

    Not applicable - non-interventional study

Study groups in NCT05280600
Study groupRoleWhat they receive
NMDAR-antibody encephalitisChildren and young people (ages 8-24 years) with a diagnosis of NMDAR-antibody encephalitis.
Receives: Other: Not applicable - non-interventional study
Antibody-negative autoimmune encephalitisChildren and young people (ages 8-24 years) with a diagnosis of autoantibody-negative but probable autoimmune encephalitis or definite autoimmune limbic encephalitis.
Receives: Other: Not applicable - non-interventional study
Healthy controlHealthy children and young people (ages 8-24 years).
Receives: Other: Not applicable - non-interventional study

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Cerebral concentrations of GABA and glutamate at the prefrontal cortex and left medial temporal lobe

    Measured with MR spectroscopy - stimulated echo acquisition mode (STEAM) sequence

    Measured: Baseline

  2. Structural MRI

    Quantitative MRI parameter maps including measurement of median T2 values in the hippocampus

    Measured: Baseline

  3. Resting-state fMRI

    Whole-brain mapping of the default mode network and seed-based analysis of hippocampal-frontal connectivity

    Measured: Baseline

Secondary outcomes (16)
  1. Wechsler Abbreviated Scale of Intelligence 2nd Edition (WASI-II)

    Cognitive test (higher score indicating better outcome)

    Measured: Baseline (all groups), 1 year (patients)

  2. Rey Auditory Verbal Learning Test (RAVLT)

    Cognitive test (higher score indicating better outcome)

    Measured: Baseline (all groups), 1 year (patients)

  3. Doors & People Test

    Cognitive test (higher score indicating better outcome)

    Measured: Baseline (all groups), 1 year (patients)

  4. CANTAB (Cambridge Cognition, UK): Paired Associates Learning

    Cognitive test (higher score indicating better outcome)

    Measured: Baseline (all groups), 1 year (patients)

  5. CANTAB (Cambridge Cognition, UK): Rapid Visual Information Processing

    Cognitive test (higher score indicating better outcome)

    Measured: Baseline (all groups), 1 year (patients)

  6. CANTAB (Cambridge Cognition, UK): Spatial Span

    Cognitive test (higher score indicating better outcome)

    Measured: Baseline (all groups), 1 year (patients)

  7. CANTAB (Cambridge Cognition, UK): Intra-Extra Dimensional Set Shift

    Cognitive test (higher score indicating better outcome)

    Measured: Baseline (all groups), 1 year (patients)

  8. CANTAB (Cambridge Cognition, UK): Stockings of Cambridge

    Cognitive test (higher score indicating better outcome)

    Measured: Baseline (all groups), 1 year (patients)

  9. CANTAB (Cambridge Cognition, UK): Stop Signal Task

    Cognitive test (higher score indicating better outcome)

    Measured: Baseline (all groups), 1 year (patients)

  10. Prodromal Questionnaire Brief Version (PQ-B)

    Questionnaire-based psychiatric symptom score (lower score indicating better outcome)

    Measured: Baseline (all groups), 1 year (patients)

  11. Patient Health Questionnaire (PHQ-9)

    Questionnaire-based psychiatric symptom score (lower score indicating better outcome)

    Measured: Baseline (all groups), 1 year (patients)

  12. Generalized Anxiety Disorder 7-item Scale (GAD-7)

    Questionnaire-based psychiatric symptom score (lower score indicating better outcome)

    Measured: Baseline (all groups), 1 year (patients)

  13. Pediatric Quality of Life Inventory (PedsQL) Generic Core Scales

    Questionnaire-based functional outcome score (higher score indicating better outcome)

    Measured: Baseline (all groups), 1 year (patients)

  14. PedsQL Multidimensional Fatigue Scale

    Questionnaire-based functional outcome score (higher score indicating better outcome)

    Measured: Baseline (all groups), 1 year (patients)

  15. Behaviour Rating Inventory of Executive Function (BRIEF)

    Questionnaire-based functional outcome score (lower score indicating better outcome)

    Measured: Baseline (all groups), 1 year (patients)

  16. Conners 3 Short Form / Conners' Adult ADHD Rating Scale

    Questionnaire-based functional outcome score (lower score indicating better outcome)

    Measured: Baseline (all groups), 1 year (patients)

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted15 Mar 2022
  2. Study start19 May 2022
  3. Primary completion28 Feb 2024 (estimated)
  4. Study completion28 Feb 2026 (estimated)

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Observational
Observational model
Cohort
Time perspective
Prospective
Enrolment
75 participants (estimated)
IDs, dates and publications
ClinicalTrials.gov ID
NCT05280600
Sponsor's protocol ID
KCL21-018
Other IDs
GN2835, IRAS 297793
Acronym
DANCE-AE
Status last verified
Oct 2023
First submitted
10 Feb 2022
Last updated
6 Oct 2023
Results posted
No
Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
Yes: Consent will be requested from participants to share imaging data and summary clinical and demographic data. Where participants consent, imaging data will be de-identified, removing facial features from the magnetic resonance images and all identifying information will be removed from the image header (the part of the file that describes how the image data was acquired). The resulting data will be shared together with anonymised clinical data at the request of other researchers.

Publications

  • Graus F, Titulaer MJ, Balu R, Benseler S, Bien CG, Cellucci T, Cortese I, Dale RC, Gelfand JM, Geschwind M, Glaser CA, Honnorat J, Hoftberger R, Iizuka T, Irani SR, Lancaster E, Leypoldt F, Pruss H, Rae-Grant A, Reindl M, Rosenfeld MR, Rostasy K, Saiz A, Venkatesan A, Vincent A, Wandinger KP, Waters P, Dalmau J. A clinical approach to diagnosis of autoimmune encephalitis. Lancet Neurol. 2016 Apr;15(4):391-404. doi: 10.1016/S1474-4422(15)00401-9. Epub 2016 Feb 20.

    PubMed 26906964

Questions about this trial

What is this clinical trial studying?

An observational study of Anti-N-Methyl-D-Aspartate Receptor Encephalitis and Autoimmune Encephalitis, run by King's College London at 1 site in United Kingdom.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 10 inclusion and 8 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: status not confirmed, as of the sponsor's last update on 6 Oct 2023. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in United Kingdom. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

Results are not available in the source record.

How can a doctor refer a patient or contact the research team?

Contact Michael R Eyre, MBBS MRes (+44 207 1887188 ext. 56322, michael.eyre@kcl.ac.uk), or a site near the patient. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Cerebral concentrations of GABA and glutamate at the prefrontal cortex and left medial temporal lobe (time frame: Baseline). The study lists 3 primary outcomes in all. It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT05280600, which also lists 1 linked publication.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 6 Oct 2023.

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