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Extreme delta brush: a unique EEG pattern in adults with anti-NMDA receptor encephalitis.
Neurology. 2012 Sep 11; 79(11):1094-100.Neur

Abstract

OBJECTIVES

To determine continuous EEG (cEEG) patterns that may be unique to anti-NMDA receptor (NMDAR) encephalitis in a series of adult patients with this disorder.

METHODS

We evaluated the clinical and EEG data of 23 hospitalized adult patients with anti-NMDAR encephalitis who underwent cEEG monitoring between January 2005 and February 2011 at 2 large academic medical centers.

RESULTS

Twenty-three patients with anti-NMDAR encephalitis underwent a median of 7 (range 1-123) days of cEEG monitoring. The median length of hospitalization was 44 (range 2-200) days. Personality or behavioral changes (100%), movement disorders (82.6%), and seizures (78.3%) were the most common symptoms. Seven of 23 patients (30.4%) had a unique electrographic pattern, which we named "extreme delta brush" because of its resemblance to waveforms seen in premature infants. The presence of extreme delta brush was associated with a more prolonged hospitalization (mean 128.3 ± 47.5 vs 43.2 ± 39.0 days, p = 0.008) and increased days of cEEG monitoring (mean 27.6 ± 42.3 vs 6.2 ± 5.6 days, p = 0.012). The modified Rankin Scale score showed a trend toward worse scores in patients with the extreme delta brush pattern (mean 4.0 ± 0.8 vs 3.1 ± 1.1, p = 0.089).

CONCLUSIONS

Extreme delta brush is a novel EEG finding seen in many patients with anti-NMDAR encephalitis. The presence of this pattern is associated with a more prolonged illness. Although the specificity of this pattern is unclear, its presence should raise consideration of this syndrome.

Authors+Show Affiliations

PENN Epilepsy Center, Department of Neurology, Hospital of the University of Pennsylvania, Philadelphia, USA. sarah.schmitt@uphs.upenn.eduNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

22933737

Citation

Schmitt, Sarah E., et al. "Extreme Delta Brush: a Unique EEG Pattern in Adults With anti-NMDA Receptor Encephalitis." Neurology, vol. 79, no. 11, 2012, pp. 1094-100.
Schmitt SE, Pargeon K, Frechette ES, et al. Extreme delta brush: a unique EEG pattern in adults with anti-NMDA receptor encephalitis. Neurology. 2012;79(11):1094-100.
Schmitt, S. E., Pargeon, K., Frechette, E. S., Hirsch, L. J., Dalmau, J., & Friedman, D. (2012). Extreme delta brush: a unique EEG pattern in adults with anti-NMDA receptor encephalitis. Neurology, 79(11), 1094-100. https://doi.org/10.1212/WNL.0b013e3182698cd8
Schmitt SE, et al. Extreme Delta Brush: a Unique EEG Pattern in Adults With anti-NMDA Receptor Encephalitis. Neurology. 2012 Sep 11;79(11):1094-100. PubMed PMID: 22933737.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Extreme delta brush: a unique EEG pattern in adults with anti-NMDA receptor encephalitis. AU - Schmitt,Sarah E, AU - Pargeon,Kimberly, AU - Frechette,Eric S, AU - Hirsch,Lawrence J, AU - Dalmau,Josep, AU - Friedman,Daniel, Y1 - 2012/08/29/ PY - 2012/8/31/entrez PY - 2012/8/31/pubmed PY - 2012/12/10/medline SP - 1094 EP - 100 JF - Neurology JO - Neurology VL - 79 IS - 11 N2 - OBJECTIVES: To determine continuous EEG (cEEG) patterns that may be unique to anti-NMDA receptor (NMDAR) encephalitis in a series of adult patients with this disorder. METHODS: We evaluated the clinical and EEG data of 23 hospitalized adult patients with anti-NMDAR encephalitis who underwent cEEG monitoring between January 2005 and February 2011 at 2 large academic medical centers. RESULTS: Twenty-three patients with anti-NMDAR encephalitis underwent a median of 7 (range 1-123) days of cEEG monitoring. The median length of hospitalization was 44 (range 2-200) days. Personality or behavioral changes (100%), movement disorders (82.6%), and seizures (78.3%) were the most common symptoms. Seven of 23 patients (30.4%) had a unique electrographic pattern, which we named "extreme delta brush" because of its resemblance to waveforms seen in premature infants. The presence of extreme delta brush was associated with a more prolonged hospitalization (mean 128.3 ± 47.5 vs 43.2 ± 39.0 days, p = 0.008) and increased days of cEEG monitoring (mean 27.6 ± 42.3 vs 6.2 ± 5.6 days, p = 0.012). The modified Rankin Scale score showed a trend toward worse scores in patients with the extreme delta brush pattern (mean 4.0 ± 0.8 vs 3.1 ± 1.1, p = 0.089). CONCLUSIONS: Extreme delta brush is a novel EEG finding seen in many patients with anti-NMDAR encephalitis. The presence of this pattern is associated with a more prolonged illness. Although the specificity of this pattern is unclear, its presence should raise consideration of this syndrome. SN - 1526-632X UR - https://www.unboundmedicine.com/medline/citation/22933737/Extreme_delta_brush:_a_unique_EEG_pattern_in_adults_with_anti_NMDA_receptor_encephalitis_ L2 - http://www.neurology.org/cgi/pmidlookup?view=long&pmid=22933737 DB - PRIME DP - Unbound Medicine ER -