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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Veröffentlicht in:Journal of clinical neurophysiology Jg. 38; H. 2; S. 124
Hauptverfasser: 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
Sprache:Englisch
Veröffentlicht: United States 01.03.2021
Schlagworte:
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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Zusammenfassung: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.
Bibliographie:ObjectType-Article-1
SourceType-Scholarly Journals-1
ObjectType-Feature-2
content type line 23
ISSN:1537-1603
1537-1603
DOI:10.1097/WNP.0000000000000654