Journal
NEUROLOGY
Volume 79, Issue 11, Pages 1094-1100Publisher
LIPPINCOTT WILLIAMS & WILKINS
DOI: 10.1212/WNL.0b013e3182698cd8
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Funding
- Eisai
- Pfizer
- UCB-Pharma
- Upsher-Smith
- Lundbeck
- GlaxoSmithKline
- Euroimmun
- National Institutes of Health [R01-NS077851, R01-MH094741]
- National Cancer Institute [R01CA89054]
- Fundacio la Marato de TV3
- McKnight Neuroscience of Brain Disorders award
- Epilepsy Study Consortium
- ICREA Funding Source: Custom
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Objectives: To determine continuous EEG (cEEG) patterns that may be unique to anti-NMDA receptor (NMDAR) encephalitis in a series of adult patients with this disorder. Methods: We evaluated the clinical and EEG data of 23 hospitalized adult patients with anti-NMDAR encephalitis who underwent cEEG monitoring between January 2005 and February 2011 at 2 large academic medical centers. Results: Twenty-three patients with anti-NMDAR encephalitis underwent a median of 7 (range 1-123) days of cEEG monitoring. The median length of hospitalization was 44 (range 2-200) days. Personality or behavioral changes (100%), movement disorders (82.6%), and seizures (78.3%) were the most common symptoms. Seven of 23 patients (30.4%) had a unique electro-graphic pattern, which we named extreme delta brush because of its resemblance to waveforms seen in premature infants. The presence of extreme delta brush was associated with a more prolonged hospitalization (mean 128.3 +/- 47.5 vs 43.2 +/- 39.0 days, p = 0.008) and increased days of cEEG monitoring (mean 27.6 +/- 42.3 vs 6.2 +/- 5.6 days, p = 0.012). The modified Rankin Scale score showed a trend toward worse scores in patients with the extreme delta brush pattern (mean 4.0 +/- 0.8 vs 3.1 +/- 1.1, p = 0.089). Conclusions: Extreme delta brush is a novel EEG finding seen in many patients with anti-NMDAR encephalitis. The presence of this pattern is associated with a more prolonged illness. Although the specificity of this pattern is unclear, its presence should raise consideration of this syndrome. Neurology (R) 2012;79:1094-1100
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