Electrographic Seizures in Patients with Acute Encephalitis

Viarasilpa, Tanuwong; Panyavachiraporn, Nicha; Osman, Gamaleldin; Parres, Christopher; Varelas, Panayiotis N.; Harn, Meredith Van; Mayer, Stephan A.

doi:10.1007/s12028-018-0599-4

Cited by 17 publications

(12 citation statements)

References 46 publications

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“…As in other studies on acute encephalitides [30], we found that 36.6% (11/30) of our patients had SCSs, a much higher percentage than those observed in both the general epileptic population (5.3%) and TLE cases (8.3%) [31,32]. Seventy-five% of the recorded SCSs occurred during sleep, and about 90% were documented by means of AEEG.…”

Section: Discussionsupporting

confidence: 76%

Seizures in autoimmune encephalitis: Findings from an EEG pooled analysis

Morano

Fanella

Irelli

et al. 2020

Seizure

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Purpose: Seizures are common in autoimmune encephalitis (AE), and an extensive work-up is required to exclude alternative etiologies. The aim of our study was to identify possible clinical/EEG peculiarities suggesting the immune-mediated origin of late-onset seizures.Methods: Thirty patients diagnosed with AE (19 men, median age 68 years, 18 seronegative) were included. Overall 212 video-electroencephalographic (EEG) and 31 24-h ambulatory EEG (AEEG) recordings were retrospectively reviewed. Posterior dominant rhythm, interictal epileptiform discharges (IEDs), clinical (CSs) and subclinical seizures (SCSs) were analyzed.Results: Six-hundred-nineteen ictal events were recorded in 19/30 subjects, mostly (568/619) during AE acute stage. Among ten patients with CSs other than faciobrachial dystonic seizures, 7 showed prominent autonomic and emotional manifestations. SCSs were detected in 11 subjects, mainly via AEEG (260/287 SCSs vs 150/332 CSs, p<0.001). Eight patients presented seizures during hyperventilation. IEDs, documented in 21 cases, were bilateral in 14 and focal temporal in 13. Multiple ictal EEG patterns were detected in 9/19 patients, 6 of whom had both CSs and SCSs, bilateral asynchronous seizures and ictal activities arising from temporal and extra-temporal regions. No correlation was found between the lateralization of MRI alterations and that of EEG findings. Conclusion:Our study confirms that adult-onset, high frequency focal seizures with prominent autonomic and emotional manifestations should be investigated for AE. Multiple ictal EEG patterns could represent a 'red flag', reflecting a widespread neuronal excitability related to the underlying immune-mediated process. Finally, our work enhances the crucial role of long-lasting EEG monitoring in revealing subclinical and relapsing seizures.

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Section: Discussionsupporting

confidence: 76%

Seizures in autoimmune encephalitis: Findings from an EEG pooled analysis

Morano

Fanella

Irelli

et al. 2020

Seizure

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“…Whilst previous literature has demonstrated that prior overt clinical seizures are the most prevalent risk factor for NCSE [6], our results suggest that autoimmune encephalitis might be as common as known epilepsy as the cause of NCSE. Whilst autoimmune encephalitis is a well-established cause of convulsive SE, there is now an increasing body of literature describing NCSE in the context of autoimmune encephalitis [7][8][9][10][11][12]. Autoimmune encephalitis is an increasingly recognised cause of encephalitis and over the last 10 years there has been a marked expansion in the range of antibodies identified [13].…”

Section: Discussionmentioning

confidence: 99%

Autoimmune encephalitis as an increasingly recognised cause of non-convulsive status epilepticus: A retrospective, multicentre evaluation of patient characteristics and electroencephalography (EEG) results

Mitchell

Valdoleiros

Jefferson

et al. 2020

Seizure

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Status epilepticus (SE) is a severe condition of unrelenting seizures requiring urgent identification and treatment. SE may be unprovoked, occurring in someone with epilepsy, or may be provoked by acute intracranial disease or metabolic derangement. Increasingly encephalitis, particularly autoimmune types, is reported to cause refractory seizures. Whilst convulsive SE is readily identified, non-convulsive SE (NCSE) can be difficult to identify clinically, and electroencephalography (EEG) is required. Therefore, it is critical to identify the key clinical features associated with NCSE on EEG to inform future use of EEG. Methods: We conducted a multicentre, retrospective analysis of EEG requests from four general and one specialist neurology hospital in the Northwest of England (2015England ( -2018. Cases were identified from EEG requests for patients with suspected NCSE or other indications such as encephalopathy. We compared demographic and clinical characteristics between EEG-confirmed cases of NCSE and a randomly selected sample of negative controls. Results: 358 EEGs were reviewed, and 8 positive cases of NCSE were identified. Epilepsy was identified as the aetiology in 2 of these cases, and autoimmune encephalitis another 2 cases (one patient with N-methyl-D-aspartate receptor antibodies and another with voltage gated potassium channel antibodies). Previous alcohol excess (p = 0.005) and subtle motor signs (p = 0.047) on examination were observed more frequently in patients with NCSE compared to controls. Conclusion: Physicians should have a low threshold for urgent EEG in patients with suspected or previous encephalitis, especially if autoimmunity is suspected or subtle motor signs are present.

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“…"lateralized periodic discharges" [LPDs]) meist im Gebiet eines Temporallappens, seltener und dann oft unabhängig voneinander in Form sog. bi-LPDs [43,57].…”

Section: A Rolle Des Eeg Im Akuten Und Längerfristigen Management Der Aieunclassified

EEG bei Autoimmunenzephalitiden

Rüegg

2020

Z. Epileptol.

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Zusammenfassung Das Elektroenzephalogramm (EEG) ist eine wichtige paraklinische, nichtinvasive, reproduzierbare Untersuchungsmethode bei der diagnostischen Abklärung einer autoimmunen Enzephalitis, und sie dient auch der Therapieüberwachung im Falle von epileptischen Anfällen oder eines Status epilepticus. Bei Letzterem hat die kontinuierliche EEG-Ableitung einen hohen Stellenwert. Die EEG-Veränderungen finden sich v. a. über den temporalen und frontalen Hirnabschnitten; meistens sind sie unspezifisch und können auch bei vielen anderen Hirnerkrankungen beobachtet werden. Einzig der sog. „extreme Delta-Brush“ deutet auf eine Anti-N-Methyl-D-Aspartat(NMDA)-Rezeptor-assoziierte autoimmune Enzephalitis hin; dessen Fehlen bedeutet aber keineswegs den Ausschluss einer solchen Erkrankung. Die im Rahmen der autoimmunen Enzephalitis infolge von Anti-Leucin-reich-Gliom-induziertes Protein‑1(LGI‑1)-Antikörpern ebenfalls fast pathognomonischen nur 1–2 s dauernden faziobrachialen dystonen Anfälle weisen meistens kein EEG-Korrelat auf. Das EEG scheint bei autoimmuner Enzephalitis über eine gewisse Voraussagekraft hinsichtlich des Verlaufs und der Prognose zu verfügen.

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Electrographic Seizures in Patients with Acute Encephalitis

Cited by 17 publications

References 46 publications

Seizures in autoimmune encephalitis: Findings from an EEG pooled analysis

Seizures in autoimmune encephalitis: Findings from an EEG pooled analysis

Autoimmune encephalitis as an increasingly recognised cause of non-convulsive status epilepticus: A retrospective, multicentre evaluation of patient characteristics and electroencephalography (EEG) results

EEG bei Autoimmunenzephalitiden

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