title: Two patients with Hashimoto's encephalopathy and uncontrolled diabetes successfully treated with levetiracetam.
abstract: Hashimoto's encephalopathy (HE) is a rare syndrome of progressive or relapsing-remitting encephalopathy associated with elevated serum anti-thyroid antibody concentrations. It is thought to be an autoimmune process that generally responds well to high-dose corticosteroids and other immunomodulatory therapies. However, some patients are unresponsive to steroids or are unable to receive immune therapy. A viable alternative is needed for this group. Given that seizure and EEG abnormalities are commonly associated with this syndrome, we postulate that treatment with levetiracetam, which has duel anti-inflammatory and anti-seizure mechanisms, might show clinical benefit. We present the cases of two patients who met the criteria for HE but were unable to receive steroids due to labile diabetes. They were both successfully treated with levetiracetam.
authors.affiliation: Department of Neurology, Boston University School of Medicine, 725 Albany St. Suite 7B, Boston, MA 02118, United States. Electronic address: lacwong@bu.edu.
authors.forename: Laura C
authors.initials: LC
authors.lastname: Wong
authors.affiliation: Department of Neurology, Boston University School of Medicine, 725 Albany St. Suite 7B, Boston, MA 02118, United States.
authors.forename: Joseph D
authors.initials: JD
authors.lastname: Freeburg
authors.affiliation: Department of Neurology, Boston University School of Medicine, 725 Albany St. Suite 7B, Boston, MA 02118, United States.
authors.forename: Georgia D
authors.initials: GD
authors.lastname: Montouris
authors.affiliation: Department of Neurology, Boston University School of Medicine, 725 Albany St. Suite 7B, Boston, MA 02118, United States.
authors.forename: Anna D
authors.initials: AD
authors.lastname: Hohler
mesh_terms: D000328:Adult; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage / Q000494:pharmacology*; D000927:Anticonvulsants / Q000008:administration & dosage / Q000494:pharmacology*; D015897:Comorbidity; D003920:Diabetes Mellitus / Q000453:epidemiology; D004660:Encephalitis / Q000188:drug therapy* / Q000453:epidemiology; D005260:Female; D050031:Hashimoto Disease / Q000188:drug therapy* / Q000453:epidemiology; D006801:Humans; D000077287:Levetiracetam; D008875:Middle Aged; D010889:Piracetam / Q000008:administration & dosage / Q000031:analogs & derivatives* / Q000494:pharmacology
chemical_list: D000893:Anti-Inflammatory Agents; D000927:Anticonvulsants; D000077287:Levetiracetam; D010889:Piracetam
keywords: Anti-epileptics; Antiinflammatory; Autoimmune thyroiditis; Hashimoto's encephalopathy; Levetiracetam; Steroid-responsive encephalopathy