Chronic periodic lateralised epileptic discharges and anti-N-methyl-D-aspartate receptor antibodies.
Periodic lateralised epileptiform discharges (PLEDs) are uncommon transient electroencephalographic findings accompanied by acute brain lesions. A small proportion of PLEDs persist for more than three months and are called "chronic" PLEDs, the pathophysiology of which is still debated. Herein, we report a man with right hemispheric PLEDs which lasted for more than 14 months and mild left hemispatial neglect after he experienced status epilepticus. Although MRI was normal, positron emission tomography revealed right temporo-parieto-occipital hypometabolism, which coincided with the source area of PLEDs estimated by magnetoencephalography. In addition, levels of anti-N-methyl-D-aspartate (NMDA) receptor antibodies and granzyme B were found to be high in the cerebrospinal fluid. Following two courses of steroid pulse therapy, the patient's left spatial neglect improved and the PLEDs were partially resolved. These findings suggest that the chronic PLEDs present in this case were an interictal phenomenon and that their pathophysiology involved autoimmune processes.
Department of Neuropsychiatry, The University of Tokyo Hospital, Tokyo.
Eisuke
E
Sakakibara
National Epilepsy Center, Shizuoka Institute of Epilepsy and Neurological Disorders, Shizuoka.
Yukitoshi
Y
Takahashi
National Center Hospital, National Center of Neurology and Psychiatry, Tokyo, Japan.
Yoshiko
Y
Murata
Department of Neuropsychiatry, The University of Tokyo Hospital, Tokyo.
Go
G
Taniguchi
National Center Hospital, National Center of Neurology and Psychiatry, Tokyo, Japan.
Daichi
D
Sone
National Center Hospital, National Center of Neurology and Psychiatry, Tokyo, Japan.
Masako
M
Watanabe
D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D000927:Anticonvulsants / Q000627:therapeutic use; D001323:Autoantibodies / Q000134:cerebrospinal fluid / Q000276:immunology*; D004827:Epilepsy / Q000134:cerebrospinal fluid / Q000276:immunology* / Q000503:physiopathology*; D007839:Functional Laterality / Q000502:physiology; D053804:Granzymes / Q000276:immunology; D006801:Humans; D008279:Magnetic Resonance Imaging; D015225:Magnetoencephalography; D008297:Male; D008775:Methylprednisolone / Q000627:therapeutic use; D008875:Middle Aged; D049268:Positron-Emission Tomography; D016194:Receptors, N-Methyl-D-Aspartate / Q000276:immunology*
D000893:Anti-Inflammatory Agents; D000927:Anticonvulsants; D001323:Autoantibodies; D016194:Receptors, N-Methyl-D-Aspartate; D053804:Granzymes; D008775:Methylprednisolone
left hemispatial neglect; magnetoencephalography; status epilepticus; steroid pulse therapy