Continuous EEG Findings in Autoimmune Encephalitis
Continuous EEG Findings in Autoimmune Encephalitis
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DOI：
10.1097/wnp.0000000000000654
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发表时间：
2021-03-01
影响因子：
2.4
通讯作者：
Rodriguez, Andres
中科院分区：
文献类型：
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作者：
Moise, Anna-Marieta;Karakis, Ioannis;Rodriguez, Andres
目的：自身免疫性脑炎（AE）是新发癫痫发作（包括新发难治性癫痫持续状态）的原因之一，但很少有研究评估AE的EEG特征。方法：对诊断为AE并接受连续EEG监测的患者进行多中心回顾性分析。结果：我们确定了64例患者（男性，39%;白色，49%;中位年龄，44岁）;其中，43例（67%）为抗体证实的AE患者。在确认抗体AE的患者中，确定了以下各项：N-甲基-D-天冬氨酸受体（n = 17，27%）、电压门控钾通道（n = 16，25%）、谷氨酸脱羧酶（n = 6，9%）和其他（n = 4，6%）。其余患者分类为很可能的抗体阴性AE（n = 11，17%）、明确的边缘系统脑炎（抗体阴性）（n = 2，3%）和桥本脑病（n = 8，13%）。53%表现出电图癫痫发作。新发难治性癫痫持续状态确定在19%的患者。63%的人有周期性或有节奏的模式，其中38%的人有加号修饰语。在33%的患者中确定了广义节律性δ活动。广义节律性δ活动和广义节律性δ活动加快速活动在抗N-甲基-D-天冬氨酸AE中更常见（分别为P = 0.0001和0.0003）。没有其他周期性或节律性模式表现出AE亚型关联。42%的患者出院时预后良好。周期性或节律性模式、癫痫发作和新发难治性癫痫持续状态会增加不良结局的风险（OR，6.4; P = 0.0012; OR，3; P = 0.0372; OR，12.3; P = 0.02）。结论：我们的研究证实了抗N-甲基-D-天冬氨酸AE的特征性EEG模式，称为极端δ刷，在我们的研究中被鉴定为广义节律性δ活动加快速活动。我们没有发现与其他AE亚型相关的其他模式。我们还发现AE患者中癫痫发作的发生率较高。最后，无论AE亚型如何，周期性或节律性模式、癫痫发作和新发难治性癫痫持续状态均增加不良结局的风险。
Purpose: Autoimmune encephalitis (AE) is a cause of new-onset seizures, including new-onset refractory status epilepticus, yet there have been few studies assessing the EEG signature of AE. Methods: Multicenter retrospective review of patients diagnosed with AE who underwent continuous EEG monitoring. Results: We identified 64 patients (male, 39%; white, 49%; median age, 44 years); of whom, 43 (67%) were antibody-proven AE patients. Of the patients with confirmed antibody AE, the following were identified: N-methyl-D-aspartate receptor (n = 17, 27%), voltage-gated potassium channel (n = 16, 25%), glutamic acid decarboxylase (n = 6, 9%), and other (n = 4, 6%). The remaining patients were classified as probable antibody-negative AE (n = 11, 17%), definite limbic encephalitis (antibody-negative) (n = 2, 3%), and Hashimoto encephalopathy (n = 8, 13%). Fifty-three percent exhibited electrographic seizures. New-onset refractory status epilepticus was identified in 19% of patients. Sixty-three percent had periodic or rhythmic patterns; of which, 38% had plus modifiers. Generalized rhythmic delta activity was identified in 33% of patients. Generalized rhythmic delta activity and generalized rhythmic delta activity plus fast activity were more common in anti-N-methyl-D-aspartate AE (P = 0.0001 and 0.0003, respectively). No other periodic or rhythmic patterns exhibited AE subtype association. Forty-two percent had good outcome on discharge. Periodic or rhythmic patterns, seizures, and new-onset refractory status epilepticus conferred an increased risk of poor outcome (OR, 6.4; P = 0.0012; OR, 3; P = 0.0372; OR, 12.3; P = 0.02, respectively). Conclusion: Our study confirms a signature EEG pattern in anti-N-methyl-D-aspartate AE, termed extreme delta brush, identified as generalized rhythmic delta activity plus fast activity in our study. We found no other pattern association with other AE subtypes. We also found a high incidence of seizures among patients with AE. Finally, periodic or rhythmic patterns, seizures, and new-onset refractory status epilepticus conferred an increased risk of poor outcome regardless of AE subtype.