Continuous EEG Findings in Autoimmune Encephalitis

Autoimmune encephalitis (AE) is a cause of new-onset seizures, including new-onset refractory status epilepticus, yet there have been few studies assessing the EEG signature of AE. Multicenter retrospective review of patients diagnosed with AE who underwent continuous EEG monitoring. We identified 6...

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Published in:	Journal of clinical neurophysiology Vol. 38; no. 2; p. 124
Main Authors:	Moise, Anna-Marieta, Karakis, Ioannis, Herlopian, Aline, Dhakar, Monica, Hirsch, Lawrence J, Cotsonis, George, LaRoche, Suzette, Cabrera Kang, Christian M, Westover, Brandon, Rodriguez, Andres
Format:	Journal Article
Language:	English
Published:	United States 01.03.2021
Subjects:	Adult Anti-N-Methyl-D-Aspartate Receptor Encephalitis - blood Anti-N-Methyl-D-Aspartate Receptor Encephalitis - diagnosis Anti-N-Methyl-D-Aspartate Receptor Encephalitis - physiopathology Autoantibodies - blood Delta Rhythm - physiology Electroencephalography - methods Electroencephalography - trends Encephalitis - blood Encephalitis - diagnosis Encephalitis - physiopathology Female Hashimoto Disease - blood Hashimoto Disease - diagnosis Hashimoto Disease - physiopathology Humans Male Middle Aged Retrospective Studies Seizures - blood Seizures - diagnosis Seizures - physiopathology Status Epilepticus - blood Status Epilepticus - diagnosis Status Epilepticus - physiopathology Young Adult
ISSN:	1537-1603, 1537-1603
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Abstract	Autoimmune encephalitis (AE) is a cause of new-onset seizures, including new-onset refractory status epilepticus, yet there have been few studies assessing the EEG signature of AE. Multicenter retrospective review of patients diagnosed with AE who underwent continuous EEG monitoring. We identified 64 patients (male, 39%; white, 49%; median age, 44 years); of whom, 43 (67%) were antibody-proven AE patients. Of the patients with confirmed antibody AE, the following were identified: N-methyl-D-aspartate receptor (n = 17, 27%), voltage-gated potassium channel (n = 16, 25%), glutamic acid decarboxylase (n = 6, 9%), and other (n = 4, 6%). The remaining patients were classified as probable antibody-negative AE (n = 11, 17%), definite limbic encephalitis (antibody-negative) (n = 2, 3%), and Hashimoto encephalopathy (n = 8, 13%). Fifty-three percent exhibited electrographic seizures. New-onset refractory status epilepticus was identified in 19% of patients. Sixty-three percent had periodic or rhythmic patterns; of which, 38% had plus modifiers. Generalized rhythmic delta activity was identified in 33% of patients. Generalized rhythmic delta activity and generalized rhythmic delta activity plus fast activity were more common in anti-N-methyl-D-aspartate AE (P = 0.0001 and 0.0003, respectively). No other periodic or rhythmic patterns exhibited AE subtype association. Forty-two percent had good outcome on discharge. Periodic or rhythmic patterns, seizures, and new-onset refractory status epilepticus conferred an increased risk of poor outcome (OR, 6.4; P = 0.0012; OR, 3; P = 0.0372; OR, 12.3; P = 0.02, respectively). Our study confirms a signature EEG pattern in anti-N-methyl-D-aspartate AE, termed extreme delta brush, identified as generalized rhythmic delta activity plus fast activity in our study. We found no other pattern association with other AE subtypes. We also found a high incidence of seizures among patients with AE. Finally, periodic or rhythmic patterns, seizures, and new-onset refractory status epilepticus conferred an increased risk of poor outcome regardless of AE subtype.
AbstractList	Autoimmune encephalitis (AE) is a cause of new-onset seizures, including new-onset refractory status epilepticus, yet there have been few studies assessing the EEG signature of AE.PURPOSEAutoimmune encephalitis (AE) is a cause of new-onset seizures, including new-onset refractory status epilepticus, yet there have been few studies assessing the EEG signature of AE.Multicenter retrospective review of patients diagnosed with AE who underwent continuous EEG monitoring.METHODSMulticenter retrospective review of patients diagnosed with AE who underwent continuous EEG monitoring.We identified 64 patients (male, 39%; white, 49%; median age, 44 years); of whom, 43 (67%) were antibody-proven AE patients. Of the patients with confirmed antibody AE, the following were identified: N-methyl-D-aspartate receptor (n = 17, 27%), voltage-gated potassium channel (n = 16, 25%), glutamic acid decarboxylase (n = 6, 9%), and other (n = 4, 6%). The remaining patients were classified as probable antibody-negative AE (n = 11, 17%), definite limbic encephalitis (antibody-negative) (n = 2, 3%), and Hashimoto encephalopathy (n = 8, 13%). Fifty-three percent exhibited electrographic seizures. New-onset refractory status epilepticus was identified in 19% of patients. Sixty-three percent had periodic or rhythmic patterns; of which, 38% had plus modifiers. Generalized rhythmic delta activity was identified in 33% of patients. Generalized rhythmic delta activity and generalized rhythmic delta activity plus fast activity were more common in anti-N-methyl-D-aspartate AE (P = 0.0001 and 0.0003, respectively). No other periodic or rhythmic patterns exhibited AE subtype association. Forty-two percent had good outcome on discharge. Periodic or rhythmic patterns, seizures, and new-onset refractory status epilepticus conferred an increased risk of poor outcome (OR, 6.4; P = 0.0012; OR, 3; P = 0.0372; OR, 12.3; P = 0.02, respectively).RESULTSWe identified 64 patients (male, 39%; white, 49%; median age, 44 years); of whom, 43 (67%) were antibody-proven AE patients. Of the patients with confirmed antibody AE, the following were identified: N-methyl-D-aspartate receptor (n = 17, 27%), voltage-gated potassium channel (n = 16, 25%), glutamic acid decarboxylase (n = 6, 9%), and other (n = 4, 6%). The remaining patients were classified as probable antibody-negative AE (n = 11, 17%), definite limbic encephalitis (antibody-negative) (n = 2, 3%), and Hashimoto encephalopathy (n = 8, 13%). Fifty-three percent exhibited electrographic seizures. New-onset refractory status epilepticus was identified in 19% of patients. Sixty-three percent had periodic or rhythmic patterns; of which, 38% had plus modifiers. Generalized rhythmic delta activity was identified in 33% of patients. Generalized rhythmic delta activity and generalized rhythmic delta activity plus fast activity were more common in anti-N-methyl-D-aspartate AE (P = 0.0001 and 0.0003, respectively). No other periodic or rhythmic patterns exhibited AE subtype association. Forty-two percent had good outcome on discharge. Periodic or rhythmic patterns, seizures, and new-onset refractory status epilepticus conferred an increased risk of poor outcome (OR, 6.4; P = 0.0012; OR, 3; P = 0.0372; OR, 12.3; P = 0.02, respectively).Our study confirms a signature EEG pattern in anti-N-methyl-D-aspartate AE, termed extreme delta brush, identified as generalized rhythmic delta activity plus fast activity in our study. We found no other pattern association with other AE subtypes. We also found a high incidence of seizures among patients with AE. Finally, periodic or rhythmic patterns, seizures, and new-onset refractory status epilepticus conferred an increased risk of poor outcome regardless of AE subtype.CONCLUSIONOur study confirms a signature EEG pattern in anti-N-methyl-D-aspartate AE, termed extreme delta brush, identified as generalized rhythmic delta activity plus fast activity in our study. We found no other pattern association with other AE subtypes. We also found a high incidence of seizures among patients with AE. Finally, periodic or rhythmic patterns, seizures, and new-onset refractory status epilepticus conferred an increased risk of poor outcome regardless of AE subtype. Autoimmune encephalitis (AE) is a cause of new-onset seizures, including new-onset refractory status epilepticus, yet there have been few studies assessing the EEG signature of AE. Multicenter retrospective review of patients diagnosed with AE who underwent continuous EEG monitoring. We identified 64 patients (male, 39%; white, 49%; median age, 44 years); of whom, 43 (67%) were antibody-proven AE patients. Of the patients with confirmed antibody AE, the following were identified: N-methyl-D-aspartate receptor (n = 17, 27%), voltage-gated potassium channel (n = 16, 25%), glutamic acid decarboxylase (n = 6, 9%), and other (n = 4, 6%). The remaining patients were classified as probable antibody-negative AE (n = 11, 17%), definite limbic encephalitis (antibody-negative) (n = 2, 3%), and Hashimoto encephalopathy (n = 8, 13%). Fifty-three percent exhibited electrographic seizures. New-onset refractory status epilepticus was identified in 19% of patients. Sixty-three percent had periodic or rhythmic patterns; of which, 38% had plus modifiers. Generalized rhythmic delta activity was identified in 33% of patients. Generalized rhythmic delta activity and generalized rhythmic delta activity plus fast activity were more common in anti-N-methyl-D-aspartate AE (P = 0.0001 and 0.0003, respectively). No other periodic or rhythmic patterns exhibited AE subtype association. Forty-two percent had good outcome on discharge. Periodic or rhythmic patterns, seizures, and new-onset refractory status epilepticus conferred an increased risk of poor outcome (OR, 6.4; P = 0.0012; OR, 3; P = 0.0372; OR, 12.3; P = 0.02, respectively). Our study confirms a signature EEG pattern in anti-N-methyl-D-aspartate AE, termed extreme delta brush, identified as generalized rhythmic delta activity plus fast activity in our study. We found no other pattern association with other AE subtypes. We also found a high incidence of seizures among patients with AE. Finally, periodic or rhythmic patterns, seizures, and new-onset refractory status epilepticus conferred an increased risk of poor outcome regardless of AE subtype.
Author	Westover, Brandon Cabrera Kang, Christian M Moise, Anna-Marieta Karakis, Ioannis Rodriguez, Andres Dhakar, Monica Herlopian, Aline LaRoche, Suzette Hirsch, Lawrence J Cotsonis, George
Author_xml	– sequence: 1 givenname: Anna-Marieta surname: Moise fullname: Moise, Anna-Marieta organization: Mission Neurosciences Program, Epilepsy Department, Mission Health, Asheville, North Carolina, U.S.A – sequence: 2 givenname: Ioannis surname: Karakis fullname: Karakis, Ioannis organization: Department of Neurology, Emory University School of Medicine, Atlanta, Georgia, U.S.A – sequence: 3 givenname: Aline surname: Herlopian fullname: Herlopian, Aline organization: Department of Neurology and Yale Comprehensive Epilepsy Center, Yale University, New Haven, Connecticut, U.S.A – sequence: 4 givenname: Monica surname: Dhakar fullname: Dhakar, Monica organization: Department of Neurology, Emory University School of Medicine, Atlanta, Georgia, U.S.A – sequence: 5 givenname: Lawrence J surname: Hirsch fullname: Hirsch, Lawrence J organization: Department of Neurology and Yale Comprehensive Epilepsy Center, Yale University, New Haven, Connecticut, U.S.A – sequence: 6 givenname: George surname: Cotsonis fullname: Cotsonis, George organization: Department of Neurology, Emory University School of Medicine, Atlanta, Georgia, U.S.A – sequence: 7 givenname: Suzette surname: LaRoche fullname: LaRoche, Suzette organization: Mission Neurosciences Program, Epilepsy Department, Mission Health, Asheville, North Carolina, U.S.A – sequence: 8 givenname: Christian M surname: Cabrera Kang fullname: Cabrera Kang, Christian M organization: Neurology Division, Laureate Medical Group, Atlanta, Georgia, U.S.A – sequence: 9 givenname: Brandon surname: Westover fullname: Westover, Brandon organization: MGH Epilepsy Service and Division of Clinical Neurophysiology, Massachusetts General Hospital, Boston, Massachusetts, U.S.A – sequence: 10 givenname: Andres surname: Rodriguez fullname: Rodriguez, Andres organization: Department of Neurology, Emory University School of Medicine, Atlanta, Georgia, U.S.A
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SubjectTerms	Adult Anti-N-Methyl-D-Aspartate Receptor Encephalitis - blood Anti-N-Methyl-D-Aspartate Receptor Encephalitis - diagnosis Anti-N-Methyl-D-Aspartate Receptor Encephalitis - physiopathology Autoantibodies - blood Delta Rhythm - physiology Electroencephalography - methods Electroencephalography - trends Encephalitis - blood Encephalitis - diagnosis Encephalitis - physiopathology Female Hashimoto Disease - blood Hashimoto Disease - diagnosis Hashimoto Disease - physiopathology Humans Male Middle Aged Retrospective Studies Seizures - blood Seizures - diagnosis Seizures - physiopathology Status Epilepticus - blood Status Epilepticus - diagnosis Status Epilepticus - physiopathology Young Adult
Title	Continuous EEG Findings in Autoimmune Encephalitis
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