Tags

Type your tag names separated by a space and hit enter

EEG extreme delta brush: An ictal pattern in patients with anti-NMDA receptor encephalitis.
Epilepsy Behav. 2015 Aug; 49:280-5.EB

Abstract

INTRODUCTION

The anti-NMDA receptor (NMDAr) encephalitis-associated syndrome includes neuropsychiatric symptoms, impaired consciousness, seizures, autonomic instability, and hypoventilation. The electroencephalographic (EEG) activity throughout the course of the disease has still not been well documented. We reviewed electroclinical data of patients with NMDAr encephalitis to characterize their EEG and its clinical correlation.

MATERIAL AND METHODS

We retrospectively identified 16 patients with NMDAr encephalitis from 8 Spanish medical centers, 15 of whom underwent video-EEG in the acute phase.

RESULTS

In 15 patients (11 females, median age: 37.4, range: 14-87 years), seizures occurred in 9 (60%) and status epilepticus (SE) in 5 (33.3%). Magnetic resonance imaging (MRI) was abnormal in 10 (66.6%), and CSF (cerebrospinal fluid) was normal in 3 and abnormal in 12, with positive PCR (polymerase chain reaction) for Mycoplasma pneumoniae (1/15) and herpes simple virus (1/15). An ovarian teratoma was found in 1 patient and other malignancies (small cell lung carcinoma) in 1 patient. The EEG was abnormal in the acute phase in 14/15 (93.3%). Extreme delta brush (EDB) was observed in 5 (33.3%), and the presence of EDB was associated with SE in all cases. Rhythmic delta activity without EDB was observed in 5 (33.3%), while excessive beta activity was present in 4 (26.6%). Extreme delta brush can follow a pattern of well-characterized electroclinical seizures.

CONCLUSIONS

Almost invariably, patients with NMDAr encephalitis had abnormal EEG. The presence of EDB, which can follow a pattern of well-characterized electroclinical seizures, in our patients was associated with seizures and SE. These findings suggest that EDB could be an evolutive pattern of an SE in NMDAr encephalitis. This article is part of a Special Issue entitled "Status Epilepticus".

Authors+Show Affiliations

Servei de Neurologia, Hospital Universitari de Bellvitge, Hospitalet de Llobregat, Spain.Servei de Neurologia, Hospital Germans Trias i Pujol, Badalona, Spain.Servei de Neurologia, Hospital de Mataró, Spain.Servei de Neurologia, Hospital de Mataró, Spain.Servei de Neurologia, Hospital Parc Taulí, Sabadell, Spain.Servei de Neurologia, Hospital Vall d´Hebrón, Barcelona, Spain.Servei de Neurologia, Hospital Clínic i Provincial, Barcelona, Spain.Servei de Neurologia, Hospital Clínic i Provincial, Barcelona, Spain.Servei de Neurologia, Hospital Universitari Josep Trueta, Girona, Spain.Servei de Neurologia, Hospital Parc Taulí, Sabadell, Spain.Servei de Neurologia, Hospital del Mar, Barcelona, Spain.Servei de Neurologia, Hospital del Mar, Barcelona, Spain.Servei de Neurologia, Hospital Universitari de Bellvitge, Hospitalet de Llobregat, Spain.Servei de Neurologia, Hospital Universitari de Bellvitge, Hospitalet de Llobregat, Spain.Servei de Neurologia, Hospital Universitari de Bellvitge, Hospitalet de Llobregat, Spain. Electronic address: mfalip@bellvitgehospital.cat.No affiliation info available

Pub Type(s)

Clinical Trial
Journal Article
Multicenter Study
Observational Study

Language

eng

PubMed ID

26071995

Citation

Veciana, M, et al. "EEG Extreme Delta Brush: an Ictal Pattern in Patients With anti-NMDA Receptor Encephalitis." Epilepsy & Behavior : E&B, vol. 49, 2015, pp. 280-5.
Veciana M, Becerra JL, Fossas P, et al. EEG extreme delta brush: An ictal pattern in patients with anti-NMDA receptor encephalitis. Epilepsy Behav. 2015;49:280-5.
Veciana, M., Becerra, J. L., Fossas, P., Muriana, D., Sansa, G., Santamarina, E., Gaig, C., Carreño, M., Molins, A., Escofet, C., Ley, M., Vivanco, R., Pedro, J., Miró, J., & Falip, M. (2015). EEG extreme delta brush: An ictal pattern in patients with anti-NMDA receptor encephalitis. Epilepsy & Behavior : E&B, 49, 280-5. https://doi.org/10.1016/j.yebeh.2015.04.032
Veciana M, et al. EEG Extreme Delta Brush: an Ictal Pattern in Patients With anti-NMDA Receptor Encephalitis. Epilepsy Behav. 2015;49:280-5. PubMed PMID: 26071995.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - EEG extreme delta brush: An ictal pattern in patients with anti-NMDA receptor encephalitis. AU - Veciana,M, AU - Becerra,J L, AU - Fossas,P, AU - Muriana,D, AU - Sansa,G, AU - Santamarina,E, AU - Gaig,C, AU - Carreño,M, AU - Molins,A, AU - Escofet,C, AU - Ley,M, AU - Vivanco,R, AU - Pedro,J, AU - Miró,J, AU - Falip,M, AU - ,, Y1 - 2015/06/10/ PY - 2015/04/09/received PY - 2015/04/17/accepted PY - 2015/6/15/entrez PY - 2015/6/15/pubmed PY - 2016/3/8/medline KW - Autoimmune KW - Encephalitis KW - Ictal pattern KW - NMDAr antibodies KW - Seizure KW - Status epilepticus SP - 280 EP - 5 JF - Epilepsy & behavior : E&B JO - Epilepsy Behav VL - 49 N2 - INTRODUCTION: The anti-NMDA receptor (NMDAr) encephalitis-associated syndrome includes neuropsychiatric symptoms, impaired consciousness, seizures, autonomic instability, and hypoventilation. The electroencephalographic (EEG) activity throughout the course of the disease has still not been well documented. We reviewed electroclinical data of patients with NMDAr encephalitis to characterize their EEG and its clinical correlation. MATERIAL AND METHODS: We retrospectively identified 16 patients with NMDAr encephalitis from 8 Spanish medical centers, 15 of whom underwent video-EEG in the acute phase. RESULTS: In 15 patients (11 females, median age: 37.4, range: 14-87 years), seizures occurred in 9 (60%) and status epilepticus (SE) in 5 (33.3%). Magnetic resonance imaging (MRI) was abnormal in 10 (66.6%), and CSF (cerebrospinal fluid) was normal in 3 and abnormal in 12, with positive PCR (polymerase chain reaction) for Mycoplasma pneumoniae (1/15) and herpes simple virus (1/15). An ovarian teratoma was found in 1 patient and other malignancies (small cell lung carcinoma) in 1 patient. The EEG was abnormal in the acute phase in 14/15 (93.3%). Extreme delta brush (EDB) was observed in 5 (33.3%), and the presence of EDB was associated with SE in all cases. Rhythmic delta activity without EDB was observed in 5 (33.3%), while excessive beta activity was present in 4 (26.6%). Extreme delta brush can follow a pattern of well-characterized electroclinical seizures. CONCLUSIONS: Almost invariably, patients with NMDAr encephalitis had abnormal EEG. The presence of EDB, which can follow a pattern of well-characterized electroclinical seizures, in our patients was associated with seizures and SE. These findings suggest that EDB could be an evolutive pattern of an SE in NMDAr encephalitis. This article is part of a Special Issue entitled "Status Epilepticus". SN - 1525-5069 UR - https://www.unboundmedicine.com/medline/citation/26071995/EEG_extreme_delta_brush:_An_ictal_pattern_in_patients_with_anti_NMDA_receptor_encephalitis_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1525-5050(15)00201-2 DB - PRIME DP - Unbound Medicine ER -