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Electroencephalographic findings in anti-N-methyl-d-aspartate receptor encephalitis in children: A series of 12 patients.
Epilepsy Behav. 2018 01; 78:118-123.EB

Abstract

OBJECTIVE

Anti-N-methyl-d-aspartate receptor encephalitis (a-NMDARe) is an acute or subacute encephalopathy where electroencephalogram (EEG) is frequently obtained as part of the workup. Although no diagnostic EEG finding has been described so far, the definition of specific or typical patterns might help to distinguish this group among various encephalopathies of childhood. We examined EEG recordings of our patients with a-NMDARe in order to describe the most frequent findings.

METHODS

Clinical and laboratory data and digital EEG recordings of 12 pediatric patients diagnosed with a-NMDARe in two major child neurology centers are evaluated.

RESULTS

We reviewed 43 EEG recordings from 12 children with a-NMDARe and followed their evolution for a median of 6 (range: 1-60) months. Initial EEG was abnormal in 11/12 patients. The most frequent finding was focal or diffuse slowing of the background rhythm. Generalized rhythmic delta activity, brief rhythmic discharges (BRDs), and occipital intermittent rhythmic delta activity (OIRDA) were seen in two patients each. Diffuse excess beta frequency activity was seen in three patients. Extreme delta brushes were observed in 5/12 (41.7%) patients, disappeared in 4-6months (two patients), or persisted at 10-17months (two patients). Epileptic activity was seen in seven patients (58%) and lateralized periodic discharges in one. On follow-up EEGs, most epileptic activity disappeared in a median of 8months.

CONCLUSIONS

A normal EEG is rare in a-NMDARe. Focal or diffuse slowing, epileptic activity, and extreme delta brush are common findings. Epileptic activity in early EEGs do not persists in most patients. Severe diffuse slowing may predict neurological impairment if confirmed in larger series.

Authors+Show Affiliations

Department of Pediatric Neurology, Hacettepe University Hospital, Ankara, Turkey. Electronic address: miracyildirim@hacettepe.edu.tr.Department of Pediatric Neurology, Hacettepe University Hospital, Ankara, Turkey.Department of Pediatric Neurology, Hacettepe University Hospital, Ankara, Turkey. Electronic address: dileky@hacettepe.edu.tr.Department of Pediatric Neurology, Hacettepe University Hospital, Ankara, Turkey. Electronic address: htopalog@hacettepe.edu.tr.Department of Pediatric Neurology, Baskent University Hospital, Adana, Turkey.Department of Pediatric Neurology, Hacettepe University Hospital, Ankara, Turkey. Electronic address: banlar@hacettepe.edu.tr.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

29179102

Citation

Yildirim, Mirac, et al. "Electroencephalographic Findings in anti-N-methyl-d-aspartate Receptor Encephalitis in Children: a Series of 12 Patients." Epilepsy & Behavior : E&B, vol. 78, 2018, pp. 118-123.
Yildirim M, Konuskan B, Yalnizoglu D, et al. Electroencephalographic findings in anti-N-methyl-d-aspartate receptor encephalitis in children: A series of 12 patients. Epilepsy Behav. 2018;78:118-123.
Yildirim, M., Konuskan, B., Yalnizoglu, D., Topaloglu, H., Erol, I., & Anlar, B. (2018). Electroencephalographic findings in anti-N-methyl-d-aspartate receptor encephalitis in children: A series of 12 patients. Epilepsy & Behavior : E&B, 78, 118-123. https://doi.org/10.1016/j.yebeh.2017.09.022
Yildirim M, et al. Electroencephalographic Findings in anti-N-methyl-d-aspartate Receptor Encephalitis in Children: a Series of 12 Patients. Epilepsy Behav. 2018;78:118-123. PubMed PMID: 29179102.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Electroencephalographic findings in anti-N-methyl-d-aspartate receptor encephalitis in children: A series of 12 patients. AU - Yildirim,Mirac, AU - Konuskan,Bahadir, AU - Yalnizoglu,Dilek, AU - Topaloglu,Haluk, AU - Erol,Ilknur, AU - Anlar,Banu, Y1 - 2017/11/25/ PY - 2017/06/29/received PY - 2017/09/07/revised PY - 2017/09/22/accepted PY - 2017/11/28/pubmed PY - 2018/12/12/medline PY - 2017/11/28/entrez KW - Anti-N-methyl-d-aspartate receptor KW - Antibody mediated KW - Autoimmune KW - Electroencephalography KW - Encephalitis KW - NMDAR SP - 118 EP - 123 JF - Epilepsy & behavior : E&B JO - Epilepsy Behav VL - 78 N2 - OBJECTIVE: Anti-N-methyl-d-aspartate receptor encephalitis (a-NMDARe) is an acute or subacute encephalopathy where electroencephalogram (EEG) is frequently obtained as part of the workup. Although no diagnostic EEG finding has been described so far, the definition of specific or typical patterns might help to distinguish this group among various encephalopathies of childhood. We examined EEG recordings of our patients with a-NMDARe in order to describe the most frequent findings. METHODS: Clinical and laboratory data and digital EEG recordings of 12 pediatric patients diagnosed with a-NMDARe in two major child neurology centers are evaluated. RESULTS: We reviewed 43 EEG recordings from 12 children with a-NMDARe and followed their evolution for a median of 6 (range: 1-60) months. Initial EEG was abnormal in 11/12 patients. The most frequent finding was focal or diffuse slowing of the background rhythm. Generalized rhythmic delta activity, brief rhythmic discharges (BRDs), and occipital intermittent rhythmic delta activity (OIRDA) were seen in two patients each. Diffuse excess beta frequency activity was seen in three patients. Extreme delta brushes were observed in 5/12 (41.7%) patients, disappeared in 4-6months (two patients), or persisted at 10-17months (two patients). Epileptic activity was seen in seven patients (58%) and lateralized periodic discharges in one. On follow-up EEGs, most epileptic activity disappeared in a median of 8months. CONCLUSIONS: A normal EEG is rare in a-NMDARe. Focal or diffuse slowing, epileptic activity, and extreme delta brush are common findings. Epileptic activity in early EEGs do not persists in most patients. Severe diffuse slowing may predict neurological impairment if confirmed in larger series. SN - 1525-5069 UR - https://www.unboundmedicine.com/medline/citation/29179102/Electroencephalographic_findings_in_anti_N_methyl_d_aspartate_receptor_encephalitis_in_children:_A_series_of_12_patients_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1525-5050(17)30532-2 DB - PRIME DP - Unbound Medicine ER -