title: Antiepileptic treatment for anti-NMDA receptor encephalitis: the need for video-EEG monitoring.
abstract: Anti-NMDA receptor encephalitis is a severe disorder characterised clinically by seizures, autonomic instability, and severe disturbances of memory, behaviour, and cognition. Due to the severity of symptoms, many patients are admitted to the intensive care unit. For some patients, the presence of various movement disorders and abnormal autonomic signs, as well as a history of seizures, lead to a false impression of status epilepticus, which is reported in 6% of the cases. Here, we present two young female patients, one of whom had ovarian teratoma. Both patients were referred to our neurological intensive care unit with a diagnosis of status epilepticus. However, prolonged video-EEG findings were compatible with encephalopathy. We avoided aggressive treatment with intravenous anaesthetics and both patients recovered after immunotherapy, one of whom received surgery. Physicians should be cautious in interpreting abnormal movements and autonomic signs in such patients and video-EEG monitoring is advised when status epilepticus is suspected. [Published with video sequences].
authors.affiliation: Department of Neurology, Hacettepe University, Ankara, Turkey. nesedericioglu@yahoo.com
authors.forename: Nese
authors.initials: N
authors.lastname: Dericioglu
authors.forename: Atay
authors.initials: A
authors.lastname: Vural
authors.forename: Pinar
authors.initials: P
authors.lastname: Acar
authors.forename: Nergiz
authors.initials: N
authors.lastname: Agayeva
authors.forename: Vefa
authors.initials: V
authors.lastname: Ismailova
authors.forename: Asli
authors.initials: A
authors.lastname: Kurne
authors.forename: Esen
authors.initials: E
authors.lastname: Saka
authors.forename: Ethem Murat
authors.initials: EM
authors.lastname: Arsava
authors.forename: Mehmet Akif
authors.initials: MA
authors.lastname: Topcuoglu
mesh_terms: D000328:Adult; D060426:Anti-N-Methyl-D-Aspartate Receptor Encephalitis / Q000150:complications / Q000175:diagnosis*; D000927:Anticonvulsants / Q000627:therapeutic use; D003937:Diagnosis, Differential; D020820:Dyskinesias / Q000175:diagnosis* / Q000209:etiology; D004569:Electroencephalography; D005260:Female; D006801:Humans; D013226:Status Epilepticus / Q000175:diagnosis* / Q000188:drug therapy; D014741:Video Recording
chemical_list: D000927:Anticonvulsants
keywords: anti-NMDA receptor encephalitis; intensive care unit; status epilepticus; video-EEG monitoring