Anti-NMDA-R encephalitis: Should we consider extreme delta brush as electrical status epilepticus?

Chanson, Eve; Bicilli, Elodie; Lauxerois, M.; Kauffmann, S.; Chabanne, Russell; Ducray, François; Honnorat, Jérôme; Clavelou, Pierre; Rosenberg, Sarah

doi:10.1016/j.neucli.2015.12.009

Cited by 32 publications

(16 citation statements)

References 15 publications

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“…Chanson et al suggest that EDB is not ictal because NCSE may be overestimated and its diagnosis is difficult without video-EEG and further invasive testing. 6 In their report, intracranial monitoring did not observe increased intracranial pressure during EDB or generalized rhythmic delta activity patterns as opposed to ictal patterns in NCSE. 7 However, EDB may also be somewhere on the ictal-interictal continuum, as Herlopian et al report a case of NMDAR encephalitis where seizures and status epilepticus evolved from the high-frequency activity of EDB.…”

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confidence: 73%

Effects of Rapid Eye Movement Sleep in Anti-NMDAR Encephalitis With Extreme Delta Brush Pattern

Jain

2020

Can. J. Neurol. Sci.

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confidence: 73%

Effects of Rapid Eye Movement Sleep in Anti-NMDAR Encephalitis With Extreme Delta Brush Pattern

Jain

2020

Can. J. Neurol. Sci.

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“…It is not influenced by sleep cycles and is continuous and symmetrical (4). Although there are authors who have proposed that this pattern emerges after status epilepticus, it has also been advocated that this pattern might be related to non-convulsive status considering that blurred consciousness continues in disease stages during which EDB is observed (5, 6). Our patient had delta waves with superimposed beta activity and this activity was observed to be diffuse on the initial investigations, and it was localized in the frontal region in the following weeks and disappeared in the 10 th week after the diagnosis was made.…”

Section: Discussionmentioning

confidence: 99%

Extreme delta brush activity; could it be a marker for early diagnosis and prognosis of anti- NMDA encephalitis?

2018

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Autoimmune encephalitis should be excluded in unexplained encephalitis. A significant portion of autoimmune encephalitis in childhood is anti- NMDA encephalitis. However, neuroimaging and routine diagnostic tests are inadequate, diagnosis sholud be confirmed by the demonstration of autoantibodies. The treatment may be delay in this process. Extreme delta brush waves are unique electroencephalography pattern, seen in some of Anti-NMDA encephalitis, useful for early diagnosis. Extreme delta brush activity is associated with prolonged hospitalization and illness. Despite of these, the specificity and sensitivity of this pattern is not-known clearly. We present a five years old boy with the loss of consciousness, involuntary movements, intermittant generalized tonic clonic seizures and extreme delta brush activity in electroencephalography.

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“…Video-electroencephalogram is highly recommended in difficult cases. If there is doubt over the diagnosis, invasive techniques should be considered in these complex situations, such as intracranial pressure monitoring and intracerebral electroencephalography [ 43 ].…”

Section: Clinical Manifestations and Neurocritical Care In The Acute mentioning

confidence: 99%

Neurocritical care for Anti-NMDA receptor encephalitis

Lin

2020

Biomedical Journal

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In this review, we summarize the clinical presentations of the acute stage of anti-N-methyl- d -aspartate (NMDA) receptor encephalitis and the neurocritical care strategy in intensive care units. Anti-NMDA receptor encephalitis has characteristic clinical features and is predominantly seen in young adults and children. Most patients have five stages of clinical presentation, including a prodromal phase, psychotic and/or seizure phase, unresponsive and/or catatonic phase, hyperkinetic phase, and gradual recovery phase. The clinical course usually begins with viral infection-like symptoms that last for up to 2 weeks (prodromal phase), followed by the rapid development of schizophrenia-like psychiatric symptoms and seizures (psychotic and seizure phase). Patients may have a decreased level of consciousness with central hypoventilation, frequently requiring mechanical ventilation. In the subsequent hyperkinetic phase, patients present with orofacial-limb dyskinesia and autonomic instability. Children with significant neurological symptoms of anti-NMDA receptor encephalitis should initially be managed in a pediatric intensive care unit. The acute critical presentations are, refractory seizures, autonomic dysfunction, hypoventilation, cardiac arrhythmia, and hyperkinetic crisis. Symptom-guided therapies and critical care are necessary in the acute stage to improve the prognosis.

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Anti-NMDA-R encephalitis: Should we consider extreme delta brush as electrical status epilepticus?

Cited by 32 publications

References 15 publications

Effects of Rapid Eye Movement Sleep in Anti-NMDAR Encephalitis With Extreme Delta Brush Pattern

Effects of Rapid Eye Movement Sleep in Anti-NMDAR Encephalitis With Extreme Delta Brush Pattern

Extreme delta brush activity; could it be a marker for early diagnosis and prognosis of anti- NMDA encephalitis?

Neurocritical care for Anti-NMDA receptor encephalitis

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