Extreme delta brush

Schmitt, Sarah; Pargeon, Kimberly; Fréchette, Éric; Hirsch, Lawrence J.; Dalmau, Josep; Friedman, Daniel J.

doi:10.1212/wnl.0b013e3182698cd8

Cited by 635 publications

(533 citation statements)

References 11 publications

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“…The authors described a rhythmic delta activity 1-3 Hz with superimposed bursts of rhythmic 20-30 Hz beta frequency activity "riding" on each delta wave. The name extreme delta brush applies because of its resemblance to the waveforms seen in premature babies [7].…”

Section: Discussionmentioning

confidence: 99%

Extreme Delta Brushes in Pediatric Anti-N-Methyl-DAspartate Receptor Encephalitis

Montenegro¹,

Lizcano²,

Cendes³

et al. 2015

J Neurol Neurosci

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Anti-N-Methyl-D-Aspartate receptor (NMDAR) encephalitis is probably the most common paraneoplastic encephalitis. In children, seizures, behavioral disturbances and abnormal movements are the most frequent symptoms. Electroencephalogram is abnormal in most patients. We report a child with anti-NMDAR encephalitis presenting extreme delta brushes in the EEG. This new EEG feature is described in patients with anti-NMDAR encephalitis, mostly adults. The identification of this EEG pattern may guide to an early diagnosis and treatment of anti-NMDAR encephalitis.

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Section: Discussionmentioning

confidence: 99%

Extreme Delta Brushes in Pediatric Anti-N-Methyl-DAspartate Receptor Encephalitis

Montenegro¹,

Lizcano²,

Cendes³

et al. 2015

J Neurol Neurosci

View full text Add to dashboard Cite

show abstract

“…Brain MRI is often normal. EEG changes in the form of extreme delta brushes have been described in comatose patients, suggestive of prolonged clinical course [4]. Relation to ovarian teratoma in females demand a thorough evaluation for occult tumors.…”

Section: Editorialmentioning

confidence: 99%

“…Numerous case reports, case series, cohort studies, randomized placebo controlled studies have reported a wide range of response (no response to significant response) [4][5][6][7][8][9]. Beware of small sample size for these studies.…”

Section: Editorialmentioning

confidence: 99%

Use of Zolpidem in Disorders of Consciousness Secondary to Autoimmune Encephalitis

Appu¹

2017

J Neuropsychiatry

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EditorialAutoimmune encephalitis is an increasingly identified area for practitioners in Neurology, Child Neurology and Psychiatry. The results of the California Encephalitis Project shed light on the importance of anti-NMDA receptor encephalitis as one more prevalent than infectious causes in younger cohort (<18 years) [1]. Since its first description in 2007, anti N-methyl Daspartate (NMDA) receptor encephalitis is an increasingly identified cause for autoimmune/paraneoplastic encephalitis [2]. Clinical features consist of a prodromal phase of infection (usually viral) associated with headaches, followed by an early phase characterized by psychosis, confusion, amnesia and dysphasia. We have reported hyper religious behavior in our patient [3]. Later stage consists of movement disorders (orolingual dyskinesia), autonomic instability (resulting in mechanical ventilation and coma) and catatonia. Brain MRI is often normal. EEG changes in the form of extreme delta brushes have been described in comatose patients, suggestive of prolonged clinical course [4]. Relation to ovarian teratoma in females demand a thorough evaluation for occult tumors. NMDA receptor encephalitis is responsive to immunotherapy (IVIG, Steroids, Plasma exchange and anti-CD20 antibody, Rituximab), if initiated early in its clinical course, and surgery as indicated for teratomas. We had previously reported a patient in minimally conscious state secondary to NMDA receptor, who after immunotherapy and tumor removal, had responded temporally to Zolpidem and would act appropriately as long as the medication lasts [3]. Based on the clinical experience, we had suggested use of Zolpidem as an adjunct to immunotherapy in patients with anti NMDA receptor encephalitis. This leads us to question the effect of Zolpidem in patients with disorders of consciousness.Zolpidem is an non benzodiazepine imidazopyridine compound that selectively binds to alpha-1 subunit of GABA-A receptor resulting in release of inhibitory neurotransmitter gamma amino butyric acid (GABA). Numerous case reports, case series, cohort studies, randomized placebo controlled studies have reported a wide range of response (no response to significant response) [4][5][6][7][8][9]. Beware of small sample size for these studies. A recent meta-analysis of 67 studies on use of Zolpidem in neurological non-insomnia cases showed that only 11 studies had 10 or more patients. The study concludes a wide range of transient efficacy for Zolpidem in a wide range of neurological disorders especially movement disorders and disorders of consciousness. However, the data is limited by small sample size of individual studies [10].Verdict-A case by case review is still required for the use of Zolpidem in patients with disorders of consciousness in general. In patients with NMDA encephalitis, Zolpidem may be a reasonable adjunct therapy after initial immunotherapy.

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“…The common pattern is slowing which may be diffuse or focal 8,10,12,18 . A recent study identified a unique EEG pattern, called "extreme delta brush" which is beta-delta complexes, in adults with anti-NMDAR encephalitis 24 . Epileptiform activity is less common than slowing 10,18 , but may include electrographic seizures in approximately 60% when continuous monitoring is undertaken 10 .…”

Section: Electroencephalogram (Eeg)mentioning

confidence: 99%

“…Changes restricted to the temporal lobe or limbic system, are the commonest findings in patients with limbic encephalitis. Abnormalities reported with more diffuse encephalitis have been in the periventricular white matter, limbic or temporal lobes 9,18,24,25 , brainstem, basal ganglia and cerebellum 12,23 . Meningeal enhancement has also been found occasionally 28 .…”

Section: Imagingmentioning

confidence: 99%

Autoimmune encephalitis: An emerging entity

Ratnayake

2013

Sri Lanka J Child Health

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Extreme delta brush

Abstract: 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.

Cited by 635 publications

References 11 publications

Extreme Delta Brushes in Pediatric Anti-N-Methyl-DAspartate Receptor Encephalitis

Extreme Delta Brushes in Pediatric Anti-N-Methyl-DAspartate Receptor Encephalitis

Use of Zolpidem in Disorders of Consciousness Secondary to Autoimmune Encephalitis

Autoimmune encephalitis: An emerging entity

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