Are There Any Specific EEG Findings in Autoimmune Epilepsies?
Are There Any Specific EEG Findings in Autoimmune Epilepsies?
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DOI：
10.1177/1550059415595907
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发表时间：
2016-07-01
影响因子：
2
通讯作者：
Baykan, Betul
中科院分区：
文献类型：
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作者：
Baysal-Kirac, Leyla;Tuzun, Erdem;Baykan, Betul
本研究评估了癫痫发作与可能的自身免疫性病因相关的患者的EEG结果。本研究的目的是通过脑电图研究寻找鉴别抗神经元抗体（Ab）患者的线索。我们回顾了我们的数据库，并确定抗神经元抗体阳性癫痫患者有或没有自身免疫性脑炎。这些患者具有针对N-甲基-d-天冬氨酸受体（NMDAR）（n = 5）、甘氨酸受体（GLY-R）（n = 5）、接触素相关蛋白样2（CASPR-2）（n = 4）、未表征的电压门控钾通道复合物（VGKC）抗原（n = 2）、谷氨酸脱羧酶（GAD）（n = 2）、Hu（n = 1）和两性啡肽（n = 1）的Ab。对照组为21例临床特征相似的血清阴性癫痫或脑病患者。脑电图结果进行了比较组间的盲法设计。抗神经元抗体阳性的癫痫患者与血清阴性的对照组的脑电图结果无显著差异。值得注意的是，四个血清阳性，但没有血清阴性患者表现为非惊厥性癫痫持续状态（NCSE）或局灶性运动癫痫持续状态。在5例（71%）血清阳性的自身免疫性脑炎患者和2例（25%）血清阴性患者中观察到连续的θ和δ节律。8例（40%）血清反应阳性患者表现为额叶间歇性节律性δ活动（FIRDA）模式，而5例（24%）血清反应阴性患者表现为额叶间歇性节律性δ活动模式。2例NMDAR Ab阳性患者显示节律性δ波叠加β频率活动，类似δ刷状模式。脑电图似乎是一个有限的诊断工具，在区分癫痫和/或脑病患者与那些没有可能的自身免疫性病因。然而，与脑炎相关的抗神经元抗体应被认为是癫痫持续状态形式的病因。在EEG中存在连续慢波、FIRDA和δ刷状模式时，可考虑癫痫发作的可能自身免疫病因。
This study evaluated the EEG findings of patients whose seizures were associated with a possible autoimmune etiology. Our aim was to find clues to distinguish patients with antineuronal antibodies (Ab) through EEG studies. We reviewed our database and identified antineuronal Ab positive epilepsy patients with or without autoimmune encephalitis. These patients had Abs to N-methyl-d-aspartate receptor (NMDAR) (n = 5), glycine receptor (GLY-R) (n = 5), contactin-associated protein-like 2 (CASPR-2) (n = 4), uncharacterized voltage-gated potassium channel complex (VGKC) antigens (n = 2), glutamic acid decarboxylase (GAD) (n = 2), Hu (n = 1), and amphiphysin (n = 1). The control group consisted of 21 seronegative epilepsy or encephalopathy patients with similar clinical features. EEG findings were compared between the groups in a blindfolded design. We did not find any significant difference in EEG findings between antineuronal Ab positive epilepsy patients and seronegative control group. It was remarkable that four seropositive but none of the seronegative patients presented with nonconvulsive status epilepticus (NCSE) or focal motor status epilepticus. Continuous theta and delta rhythms were observed in 5 (71%) seropositive patients with autoimmune encephalitis and 2 (25%) seronegative patients. Eight (40 %) seropositive patients showed a frontal intermittent rhythmic delta activity (FIRDA) pattern as opposed to 5 (24%) seronegative patients. Two patients with NMDAR Ab positivity showed rhythmic delta waves superimposed with beta frequency activity resembling delta brush pattern. EEG seems as a limited diagnostic tool in differentiating epilepsy and/or encephalopathy patients with a possible autoimmune etiology from those without. However, antineuronal Abs associated with encephalitis should be considered in the etiology of status epilepticus forms. A possible autoimmune etiology for seizures may be considered in the presence of continuous slow waves, FIRDA, and delta brush pattern in the EEG.