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Compensatory mechanisms in Rasmussen's Encephalitis

Rasmussen encephalitis (RE) is a chronic immune-mediated brain disease that is characterized by therapy-refractory seizures, progredient neurological deficits and – most strikingly – progressive unihemispheric atrophy. Although it is regarded as a strictly one-sided pathology, volumetric MRI studies have revealed atrophy of the so-called “unaffected” hemisphere as well.


In contrast to previous studies, we hypothesize the contralesional hemisphere to show signs of compensation for ipsilesional atrophy, thereby questioning the concept of the “unaffected” hemisphere in Rasmussen encephalitis. We aim to further describe cortical and subcortical alterations in RE by means of volumetric and surface-based analyses, validating our previous results with a large data set and a detailed longitudinal design. We contrive concepts involving computational models to reveal complex patterns of atrophy and compensational mechanisms, since a deep understanding is of high clinical relevance.

Morphometric MRI findings challenge the concept of the "unaffected" hemisphere in Rasmussen encephalitis. Epilepsia. David et al. (2019) 60(5):e40-e46. doi: 10.1111/epi.14702.

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Volumetric and surface-based analyses of subcortical structures are of high interest to reveal complex atrophy patterns and compensational mechanisms in RE

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Voxel-based morphometry (VBM) shows higher cortical volumes on "unaffected" hemisphere im RE patients

Right: MRI of RE patient shows progressive unihemispheric atrophy

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