EEG analysis in anti-NMDA receptor encephalitis: Description of typical patterns

Jeannin-Mayer, Sophie; André‐Obadia, Nathalie; Rosenberg, Sarah; Billen, Claire; Honnorat, Jérôme; Antoine, Jean‐Christophe; Mazzola, Laure

doi:10.1016/j.clinph.2018.10.017

Cited by 61 publications

(69 citation statements)

References 31 publications

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“…14 exist. 15,16 In our experience, clinical and EEG data suggest a temporal lobe origin of the majority of seizures. These are characterized mainly by impaired awareness and orofacial or manual automatisms.…”

Section: Encephalitis With Nmda-sensitive Glutamatergic Receptor Anmentioning

confidence: 57%

“…Seizure semiology and ictal onset have been reported to be temporal, extratemporal, or multifocal, reflecting the more diffuse cortical dysfunction present in NMDAR‐Ab–associated syndrome as compared to classical limbic encephalitis cases . Few detailed ictal video‐EEG descriptions exist . In our experience, clinical and EEG data suggest a temporal lobe origin of the majority of seizures.…”

Section: Main Subtypes Of Ae and Pns Associated With Epilepsymentioning

confidence: 59%

“…Because AED intensification had no effect on GDA and associated hyperkinetic movements, the rhythmic aspect of this EEG pattern should not be misinterpreted as status epilepticus. The importance of continuous EEG monitoring is corroborated by the finding that in up to 20% of patients, mainly in those with a decreased level of consciousness, subclinical epileptic discharges are observed …”

Section: Main Subtypes Of Ae and Pns Associated With Epilepsymentioning

confidence: 95%

“…This pattern should raise consideration of NMDAR‐Ab encephalitis, but is not pathognomonic, being described in association with other etiologies in critically ill adults . Recently, two novel EEG patterns have also been described in association with NMDAR‐Ab encephalitis: excessive beta activity in the range of 14‐20 Hz (EBA) and generalized delta activity (GDA), the latter being defined by the presence of diffuse, synchronous, and rhythmic delta activity (Figure D) . They follow a peculiar chronological order over the course of the disease: EBA appears first and is frontally predominant, followed by EDB and GDA.…”

Section: Main Subtypes Of Ae and Pns Associated With Epilepsymentioning

confidence: 97%

“…These are characterized mainly by impaired awareness and orofacial or manual automatisms. Some, however, originate from the frontocentral regions, leading to prevalent motor manifestations, such as tonic or clonic seizures (Figure ) . Status epilepticus has been reported to occur in 6% to 40% of patients .…”

Section: Main Subtypes Of Ae and Pns Associated With Epilepsymentioning

confidence: 99%

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Seizure specificities in patients with antibody‐mediated autoimmune encephalitis

et al. 2019

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Accumulating data on patients with autoimmune encephalitis have shed light on specificities concerning clinical presentation and outcomes, which are dependent on the antigen targeted by the autoantibodies found in the patients’ cerebrospinal fluid or sera. Such specificities include seizure‐related clinical manifestations as well as the responsiveness to antiepileptic drugs. Although increased enthusiasm accompanies the discovery of novel antibodies and their associated clinical syndromes, several issues remain unsettled. First, it appears that therapy needs to be personalized in the view of the severity of each antibody‐mediated syndrome, patient‐related characteristics, and timing of treatment. Second, the lack of randomized controlled trials is a major drawback in the formulation of an appropriate immunotherapeutic strategy. In this review, we discuss the novel developments and challenges for the diagnosis and treatment of epilepsy in patients with well‐characterized autoimmune encephalitis, and delineate the principles for a rational approach toward precision medicine in this emerging field.

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Section: Encephalitis With Nmda-sensitive Glutamatergic Receptor Anmentioning

confidence: 57%

Section: Main Subtypes Of Ae and Pns Associated With Epilepsymentioning

confidence: 59%

Section: Main Subtypes Of Ae and Pns Associated With Epilepsymentioning

confidence: 95%

Section: Main Subtypes Of Ae and Pns Associated With Epilepsymentioning

confidence: 97%

Section: Main Subtypes Of Ae and Pns Associated With Epilepsymentioning

confidence: 99%

See 3 more Smart Citations

Seizure specificities in patients with antibody‐mediated autoimmune encephalitis

et al. 2019

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Delta brush variant: A novel ictal EEG pattern in anti‐NMDAR encephalitis

Huang

Liao

et al. 2020

Epilepsia Open

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Seizure is one of the main symptoms of anti‐NMDAR encephalitis, but data of ictal electroencephalogram (EEG) patterns remain limited. In this study, we aimed to introduce a unique ictal pattern. This delta brush variant (DBV) was characterized as generalized delta rhythm with fast spike activity riding on it. We retrospectively evaluated the ictal pattern from six patients with anti‐NMDAR encephalitis, and patients were grouped based on the presence of DBV. DBV was found in two patients who were in the florid phase of the disease: (a) A 17‐year‐old girl experienced rhythmical jerking of bilateral limbs. Corresponding EEG patterns showed generalized DBV. Seizure terminated after intravenous injection of midazolam, but oral‐facial dyskinesia reappeared; and (b) a 24‐year‐old man suffered stiffening of the right limbs and oral‐facial dyskinesia. The EEG pattern showed frontal DBV with left prominence. Seizure was controlled, but oral‐facial dyskinesia remained after intravenous injection of midazolam. Compared with patients without DBV, patients in this group were more likely to have prolonged excessive delta brush (100% vs 25%) and hyperpyrexia (39.7℃ vs 38.2℃). Duration in ICU (36 days vs 18 days) and hospital (52 days vs 36 days) was relatively longer in DBV group, and no significant difference was found in terms of the mRS score (1 vs 0.5) and seizure relapse rate (0% vs 25%) during 3‐month follow‐up. DBV is a peculiar pattern in anti‐NMDAR encephalitis. An EEG‐based monitoring should be considered to avoid misleading this ictal EEG pattern to the electromyographic artifact.

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Response: Extreme delta brush in anti‐NMDAR encephalitis—Mimics and chameleons

Huang

Liao

et al. 2021

Epilepsia Open

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EEG analysis in anti-NMDA receptor encephalitis: Description of typical patterns

Cited by 61 publications

References 31 publications

Seizure specificities in patients with antibody‐mediated autoimmune encephalitis

Seizure specificities in patients with antibody‐mediated autoimmune encephalitis

Delta brush variant: A novel ictal EEG pattern in anti‐NMDAR encephalitis

Response: Extreme delta brush in anti‐NMDAR encephalitis—Mimics and chameleons

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