title: Hashimoto's myoclonic encephalopathy: an underdiagnosed treatable condition?
abstract: We report two patients with subacute diffuse encephalopathy characterized by confusion, myoclonic encephalopathy, and mild akineto-rigid extrapyramidal signs in one case and by apathy, memory deficit, and partial complex seizures in the other. Hashimoto's thyroiditis with high titers of anti-thyroglobulin antibodies was diagnosed in both patients, who were unresponsive to anticonvulsant medication, but showed rapid neurological improvement following steroid treatment. On neuropsychological examination, predominant frontotemporal dysfunction was noted. Electroencephalographic activity was remarkable for its rhythmical delta activity, unresponsive to, or even paradoxically increased by, anticonvulsant treatment. On magnetic resonance imaging, atrophy with temporal predominance was found. These observations support the idea that this potentially treatable dementia and movement disorder should be classified as a separate clinical entity.
authors.affiliation: Service de Neurologie, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.
authors.forename: F
authors.initials: F
authors.lastname: Ghika-Schmid
authors.forename: J
authors.initials: J
authors.lastname: Ghika
authors.forename: F
authors.initials: F
authors.lastname: Regli
authors.forename: N
authors.initials: N
authors.lastname: Dworak
authors.forename: J
authors.initials: J
authors.lastname: Bogousslavsky
authors.forename: C
authors.initials: C
authors.lastname: Städler
authors.forename: L
authors.initials: L
authors.lastname: Portmann
authors.forename: P A
authors.initials: PA
authors.lastname: Despland
mesh_terms: D000328:Adult; D000368:Aged; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage / Q000627:therapeutic use; D000927:Anticonvulsants / Q000008:administration & dosage / Q000627:therapeutic use; D001921:Brain / Q000503:physiopathology*; D002998:Clonazepam / Q000008:administration & dosage / Q000627:therapeutic use; D003072:Cognition Disorders / Q000175:diagnosis; D004569:Electroencephalography; D005116:Extrapyramidal Tracts / Q000503:physiopathology; D005260:Female; D005625:Frontal Lobe / Q000503:physiopathology; D006801:Humans; D008775:Methylprednisolone / Q000008:administration & dosage / Q000627:therapeutic use; D009207:Myoclonus / Q000188:drug therapy / Q000503:physiopathology*; D009483:Neuropsychological Tests; D011241:Prednisone / Q000008:administration & dosage / Q000627:therapeutic use; D013702:Temporal Lobe / Q000503:physiopathology; D013967:Thyroiditis, Autoimmune / Q000175:diagnosis / Q000188:drug therapy / Q000503:physiopathology; D013972:Thyrotropin / Q000378:metabolism
chemical_list: D000893:Anti-Inflammatory Agents; D000927:Anticonvulsants; D002998:Clonazepam; D013972:Thyrotropin; D011241:Prednisone; D008775:Methylprednisolone