EEG findings in steroid-responsive encephalopathy associated with autoimmune thyroiditis

Schäuble, Barbara; Castillo, Pablo R.; Boeve, Bradley F.; Westmoreland, Barbara F.

doi:10.1016/s1388-2457(02)00343-7

Cited by 126 publications

(95 citation statements)

References 28 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…In addition, the presence of serum antibodies against NAE, which is a recognized diagnostic marker for HE (5), supported this diagnosis in our patient. Our patient met the diagnostic criteria for HE proposed by Schauble et al (6) despite the fact that his cognitive function did not improve after treatment with prednisolone. Although a pathological evaluation performed to make the differential diagnosis of neuro-Behcet's disease was lacking, we found no clinical characteristics of Behcet's disease, such as oral ulcerations, headaches, fever, urogenital ulcerations or uveitis.…”

Section: Discussionmentioning

confidence: 40%

Steroid-responsive Thalamic Lesions Accompanying Microbleeds in a Case of Hashimoto's Encephalopathy with Autoantibodies Against α-enolase

et al. 2013

View full text Add to dashboard Cite

A 67-year-old man receiving antithrombotic therapy developed rapidly progressive amnesia. T2-weighted images of brain MRI revealed hyperintense lesions in the bilateral thalami accompanied by microbleeds. Antithyroglobulin antibodies and autoantibodies against the N-terminal of α-enolase (NAE) were identified in the patient's serum; therefore, Hashimoto's encephalopathy (HE) was suspected. Although the patient's radiological findings improved following steroid therapy, his symptoms did not improve, possibly due to increased thalamic microbleeds. Because anti-NAE antibodies are possibly associated with vasculitis, HE accompanied by anti-NAE antibodies may be exacerbated by microbleeds in patients receiving antithrombotic therapy.

show abstract

Section: Discussionmentioning

confidence: 40%

Steroid-responsive Thalamic Lesions Accompanying Microbleeds in a Case of Hashimoto's Encephalopathy with Autoantibodies Against α-enolase

et al. 2013

View full text Add to dashboard Cite

show abstract

“…Our patient had normal neuroimaging (Figure 1-3). EEG may show various degrees of slowing and/or triphasic waves [10]. Focal slowing, focal epileptiform discharges, periodic lateralized epileptiform discharges have been seen in isolated cases [7,11,12].…”

Section: Discussionmentioning

confidence: 99%

Hormone Responsive Hashimoto Encephalopathy: A Case of Hashimoto Encephalopathy Treated with only Oral Thyroid Medication and Symptomatic Therapy for Seizures and Psychosis, but without Steroids

Kapoor¹,

Sharma²,

Couch³

2017

JNSK

View full text Add to dashboard Cite

Hashimoto encephalopathy is a rare disease associated with autoimmune thyroiditis. Symptoms may include delirium, encephalopathy, seizures, and psychosis. Pathophysiology of this disease is not completely understood. This condition is often under-diagnosed if not suspected and should be considered in patients with diverse neuropsychiatric manifestations in whom no obvious etiology of encephalopathy can be determined. Anti-thyroid antibodies and thyroid peroxidase antibodies are crucial for diagnosis. Along with supportive management, empiric steroid treatment is usually administered as soon as infectious and other causes are ruled out. We report a case of Hashimoto thyroiditis which presented with agitation, psychosis, hallucinations, complex partial seizures. In this case the disease was controlled with only oral thyroid therapy and supportive management with antiepileptic drugs and antipsychotic drugs, but without the use of steroids.Keywords: Hashimoto encephalopathy; Autoimmune thyroiditis; Seizures; Delirium IntroductionHashimoto encephalopathy was first described in 1966 by Brain et al. [1] in a 49-year-old man with progressive impairment of consciousness and cognition interspersed with episodes of confusion or coma, agitation, hallucinations, tremor and recurrent stroke-like episodes, who had histologically confirmed Hashimoto thyroiditis [1]. Several cases of Hashimoto encephalopathy have been reported since then [2][3][4][5]. There are however controversies regarding its establishment as a specific disorder. Case HistoryA retired 71-year-old man living independently presented to the emergency department with new onset complex partial seizures and psychotic behavior. Laboratory work up revealed normal complete blood count, serum electrolytes, kidney function and liver function, however his thyroid stimulating hormone level was high with low free thyroxine levels. Magnetic resonance imaging of brain was normal. A preliminary diagnosis of secondary seizure was made and the patient was treated with antiepileptic drugs and was discharged home on oral thyroid supplement with plans to obtain an outpatient electroencephalogram and neurology follow up in clinic. The seizures recurred and his psychosis worsened over next two days evolving to partial complex status epilepticus and encephalopathy with delirium. He presented again to the emergency department and was admitted for further workup and management. Electroencephalogram was severely abnormal with diffuse polymorphic slowing and sharp wave activity suggesting epileptic encephalopathy. His clinical course at that time was associated with delirium and acute psychosis manifested as visual hallucinations, agitation, manic episodes and insomnia.Laboratory work up revealed normal complete blood count, serum electrolytes, kidney function and liver function, his thyroid stimulating hormone was elevated to 77.4 and free thyroxine levels was very low, 0.8. Cerebrospinal fluid analysis was normal, no evidence of infection was found in blood, urine and cerebros...

show abstract

“…EEG is almost always markedly altered, and seizures are present in 70-80% of patients, whereas status epilepticus occurs in 10-20%. [65] However, EEG patterns and seizuretypes are diverse. The clinical response to high-dose steroids is taken within days as complete or near complete.…”

Section: Systemic Lupus Erythematosusmentioning

confidence: 99%

Epilepsy and Autoimmunity

Çoban¹,

Eki̇zoğlu²,

Tüzün³

2013

Epilepsi

View full text Add to dashboard Cite

SummaryEpilepsy may present as a symptom of many neurological disorders and often an etiological factor cannot be identified. There is some evidence that immune mechanisms might play a role in the pathogenesis of certain epileptic syndromes. The evidence in support of this idea includes apparent association of seizures with certain autoimmune diseases, numerous reports of the detection of theoretically relevant serum autoantibodies, an acute or subacute onset of the seizures, a rapidly progressive course, and a favorable response to immunotherapy.In this article, we summarize (i) epilepsies where clinical and biologic data strongly support the pathogenic role of autoantibodies. (ii) epilepsies where immune-mediated inflammation occurs, but the full pathogenic cascade is either not clear or only strongly hypothesized and (iii) autoimmune diseases associated with seizures or epilepsy.Key words: Autoantibodies; autoimmunity; epilepsy. ÖzetEpilepsi birçok nörolojik hastalığın belirtisi olarak ortaya çıkabilir ve sıklıkla etiyolojik faktör tespit edilemez. İmmün mekanizmaların belirli epileptik sendromların patogenezinde rol oynayabileceğine dair bazı kanıtlar vardır. Belli otoimmün hastalıklar ile nöbetlerin açık bir şekilde ilişkili olması, teorik olarak uygun serum otoantikorlarının saptandığı çok sayıda bildirinin olması, akut ya da subakut başlangıçlı nöbetler, hızlı ilerleyici bir seyir ve immünoterapiye olumlu cevap alınması bu fikri destekleyen kanıtlardır. Bu makale, (i) epilepsilerin klinik ve biyolojik verilerinin otoantikorların patolojik rolünü kuvvetli bir şekilde desteklediğini (ii) epilepsilerde immün aracılı inflamasyonun oluştuğunu ancak tam patojenik kaskadın net olmadığını ya da sadece kuvvetli bir hipotez olduğunu ve (iii) epilepsi ya da nöbetlerle ilişkili otoimmün hastalıkları özetlemektedir.

show abstract

EEG findings in steroid-responsive encephalopathy associated with autoimmune thyroiditis

Cited by 126 publications

References 28 publications

Steroid-responsive Thalamic Lesions Accompanying Microbleeds in a Case of Hashimoto's Encephalopathy with Autoantibodies Against α-enolase

Steroid-responsive Thalamic Lesions Accompanying Microbleeds in a Case of Hashimoto's Encephalopathy with Autoantibodies Against α-enolase

Hormone Responsive Hashimoto Encephalopathy: A Case of Hashimoto Encephalopathy Treated with only Oral Thyroid Medication and Symptomatic Therapy for Seizures and Psychosis, but without Steroids

Epilepsy and Autoimmunity

Contact Info

Product

Resources

About