Serial and prolonged EEG monitoring in anti-N-Methyl-d-Aspartate receptor encephalitis.
OBJECTIVE
To describe serial electroencephalographic (EEG) findings of three patients with anti-NMDAR encephalitis.


METHODS
Three women (age 15-34years) with confirmed anti-NMDAR encephalitis underwent serial EEG recordings. Continuous EEG for 72h was performed in one case and 3-day video-EEG monitoring was obtained in two cases.


RESULTS
Generalized rhythmic delta activity (GRDA) was found in all patients. GRDA persisted for hours, but was not continuous on a 24-h EEG recording, disclosed no frequency, voltage or field evolution, and was not seen on the first EEG of two patients. Extreme delta brush was noted in two patients who presented more severe disease. One patient presented seizures, which were electrographically and clinically different from the GRDA pattern and from dyskinetic movements.


CONCLUSIONS
Serial or continuous EEG may be necessary to detect GRDA in anti-NMDAR patients. To avoid unnecessary treatment, this pattern should not be interpreted as indicative of ictal activity, unless there is evidence of its ictal nature.


CONCLUSIONS
Our findings may contribute to the diagnosis of anti-NMDAR encephalitis in cases with characteristic clinical picture.
Department of Neurology, University of São Paulo, São Paulo, Brazil. Electronic address: franciscops@hotmail.com.
Francisco Pereira
FP
da Silva-Júnior
Department of Neurology, University of São Paulo, São Paulo, Brazil.
Luiz Henrique Martins
LH
Castro
Department of Neurology, University of São Paulo, São Paulo, Brazil.
Joaquina Queiroz
JQ
Andrade
Department of Neurology, University of São Paulo, São Paulo, Brazil.
Carla Guimarães
CG
Bastos
Department of Neurology, University of São Paulo, São Paulo, Brazil.
Camila Hobi
CH
Moreira
Department of Neurology, University of São Paulo, São Paulo, Brazil.
Rosa Maria Figueiredo
RM
Valério
Department of Neurology, University of São Paulo, São Paulo, Brazil.
Carmen Lisa
CL
Jorge
Department of Neurology, University of São Paulo, São Paulo, Brazil.
Paulo Eurípedes
PE
Marchiori
Department of Neurology, University of São Paulo, São Paulo, Brazil.
Ricardo
R
Nitrini
Department of Neurology, University of São Paulo, São Paulo, Brazil.
Eliana
E
Garzon
D000293:Adolescent; D000328:Adult; D060426:Anti-N-Methyl-D-Aspartate Receptor Encephalitis / Q000150:complications / Q000175:diagnosis* / Q000209:etiology; D001569:Benzodiazepines / Q000008:administration & dosage; D003700:Delta Rhythm; D004569:Electroencephalography / Q000187:drug effects / Q000379:methods*; D004784:Environmental Monitoring / Q000379:methods; D005260:Female; D006801:Humans; D007275:Injections, Intravenous; D012640:Seizures / Q000209:etiology; D020521:Stroke; D055815:Young Adult
D001569:Benzodiazepines
Anti-N-Methyl-d-Aspartate receptor; Electroencephalography; Encephalitis