title: Focal seizures in children with anti-NMDA receptor antibody encephalitis.
abstract: OBJECTIVE
  We investigated the electroclinical features of seizures occurring in children with anti-NMDA receptor antibody encephalitis.
  
  
  METHODS
  Clinical features and video EEG recordings were analyzed from pediatric patients with anti-NMDA receptor antibody encephalitis at our center over a six year period.
  
  
  RESULTS
  We identified eight pediatric patients with anti-NMDA receptor antibody encephalitis. Video EEG captured multiple focal seizures in four patients. Ictal onset in all four patients consisted of a focal rhythmic sharpened 6-12Hz activity that subsequently spread to one or both hemispheres. When there was a clinical correlate, seizure semiology was limb posturing with or without dyscognitive features. While background abnormalities were noted at presentation in three cases, the initial EEG background was normal in five, including three patients presenting with seizures. The EEG background deteriorated with clinical progression.
  
  
  CONCLUSIONS
  Focal seizures are common in pediatric patients with anti-NMDA receptor antibody encephalitis and have a characteristic ictal onset pattern. Anti-NMDA receptor antibody encephalitis should be considered in the differential diagnosis of a child presenting with new onset focal seizures, irrespective of the EEG background, especially if accompanied by dyskinesia, psychiatric symptoms or impaired cognition.
authors.affiliation: The University of San Francisco, Benioff Children's Hospital-San Francisco, Neurology, Mailstop 0137, 550 16th Street, 4th Floor, San Francisco, CA 94158-2549, United States. Electronic address: tristan.sands@ucsf.edu.
authors.forename: Tristan T
authors.initials: TT
authors.lastname: Sands
authors.affiliation: The University of San Francisco, Benioff Children's Hospital-San Francisco, Neurology, Mailstop 0137, 550 16th Street, 4th Floor, San Francisco, CA 94158-2549, United States. Electronic address: kendall.nash@ucsf.edu.
authors.forename: Kendall
authors.initials: K
authors.lastname: Nash
authors.affiliation: The University of San Francisco, Benioff Children's Hospital-San Francisco, Neurology, Mailstop 0137, 550 16th Street, 4th Floor, San Francisco, CA 94158-2549, United States. Electronic address: son.tong@ucsf.edu.
authors.forename: Son
authors.initials: S
authors.lastname: Tong
authors.affiliation: The University of San Francisco, Benioff Children's Hospital-San Francisco, Neurology, Mailstop 0137, 550 16th Street, 4th Floor, San Francisco, CA 94158-2549, United States. Electronic address: joseph.sullivan@ucsf.edu.
authors.forename: Joseph
authors.initials: J
authors.lastname: Sullivan
mesh_terms: D000293:Adolescent; D060426:Anti-N-Methyl-D-Aspartate Receptor Encephalitis / Q000150:complications* / Q000175:diagnosis; D002648:Child; D002675:Child, Preschool; D004569:Electroencephalography; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D012189:Retrospective Studies; D012640:Seizures / Q000150:complications* / Q000175:diagnosis
keywords: EEG, Seizure; Encephalitis; NMDA; Pediatric