title: EEG extreme delta brush: An ictal pattern in patients with anti-NMDA receptor encephalitis.
abstract: BACKGROUND
  The anti-NMDA receptor (NMDAr) encephalitis-associated syndrome includes neuropsychiatric symptoms, impaired consciousness, seizures, autonomic instability, and hypoventilation. The electroencephalographic (EEG) activity throughout the course of the disease has still not been well documented. We reviewed electroclinical data of patients with NMDAr encephalitis to characterize their EEG and its clinical correlation.
  
  
  METHODS
  We retrospectively identified 16 patients with NMDAr encephalitis from 8 Spanish medical centers, 15 of whom underwent video-EEG in the acute phase.
  
  
  RESULTS
  In 15 patients (11 females, median age: 37.4, range: 14-87 years), seizures occurred in 9 (60%) and status epilepticus (SE) in 5 (33.3%). Magnetic resonance imaging (MRI) was abnormal in 10 (66.6%), and CSF (cerebrospinal fluid) was normal in 3 and abnormal in 12, with positive PCR (polymerase chain reaction) for Mycoplasma pneumoniae (1/15) and herpes simple virus (1/15). An ovarian teratoma was found in 1 patient and other malignancies (small cell lung carcinoma) in 1 patient. The EEG was abnormal in the acute phase in 14/15 (93.3%). Extreme delta brush (EDB) was observed in 5 (33.3%), and the presence of EDB was associated with SE in all cases. Rhythmic delta activity without EDB was observed in 5 (33.3%), while excessive beta activity was present in 4 (26.6%). Extreme delta brush can follow a pattern of well-characterized electroclinical seizures.
  
  
  CONCLUSIONS
  Almost invariably, patients with NMDAr encephalitis had abnormal EEG. The presence of EDB, which can follow a pattern of well-characterized electroclinical seizures, in our patients was associated with seizures and SE. These findings suggest that EDB could be an evolutive pattern of an SE in NMDAr encephalitis. This article is part of a Special Issue entitled "Status Epilepticus".
authors.affiliation: Servei de Neurologia, Hospital Universitari de Bellvitge, Hospitalet de Llobregat, Spain.
authors.forename: M
authors.initials: M
authors.lastname: Veciana
authors.affiliation: Servei de Neurologia, Hospital Germans Trias i Pujol, Badalona, Spain.
authors.forename: J L
authors.initials: JL
authors.lastname: Becerra
authors.affiliation: Servei de Neurologia, Hospital de Mataró, Spain.
authors.forename: P
authors.initials: P
authors.lastname: Fossas
authors.affiliation: Servei de Neurologia, Hospital de Mataró, Spain.
authors.forename: D
authors.initials: D
authors.lastname: Muriana
authors.affiliation: Servei de Neurologia, Hospital Parc Taulí, Sabadell, Spain.
authors.forename: G
authors.initials: G
authors.lastname: Sansa
authors.affiliation: Servei de Neurologia, Hospital Vall d´Hebrón, Barcelona, Spain.
authors.forename: E
authors.initials: E
authors.lastname: Santamarina
authors.affiliation: Servei de Neurologia, Hospital Clínic i Provincial, Barcelona, Spain.
authors.forename: C
authors.initials: C
authors.lastname: Gaig
authors.affiliation: Servei de Neurologia, Hospital Clínic i Provincial, Barcelona, Spain.
authors.forename: M
authors.initials: M
authors.lastname: Carreño
authors.affiliation: Servei de Neurologia, Hospital Universitari Josep Trueta, Girona, Spain.
authors.forename: A
authors.initials: A
authors.lastname: Molins
authors.affiliation: Servei de Neurologia, Hospital Parc Taulí, Sabadell, Spain.
authors.forename: C
authors.initials: C
authors.lastname: Escofet
authors.affiliation: Servei de Neurologia, Hospital del Mar, Barcelona, Spain.
authors.forename: M
authors.initials: M
authors.lastname: Ley
authors.affiliation: Servei de Neurologia, Hospital del Mar, Barcelona, Spain.
authors.forename: R
authors.initials: R
authors.lastname: Vivanco
authors.affiliation: Servei de Neurologia, Hospital Universitari de Bellvitge, Hospitalet de Llobregat, Spain.
authors.forename: J
authors.initials: J
authors.lastname: Pedro
authors.affiliation: Servei de Neurologia, Hospital Universitari de Bellvitge, Hospitalet de Llobregat, Spain.
authors.forename: J
authors.initials: J
authors.lastname: Miró
authors.affiliation: Servei de Neurologia, Hospital Universitari de Bellvitge, Hospitalet de Llobregat, Spain. Electronic address: mfalip@bellvitgehospital.cat.
authors.forename: M
authors.initials: M
authors.lastname: Falip
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D060426:Anti-N-Methyl-D-Aspartate Receptor Encephalitis / Q000150:complications / Q000209:etiology / Q000503:physiopathology*; D000927:Anticonvulsants / Q000627:therapeutic use; D003700:Delta Rhythm; D004569:Electroencephalography; D020803:Encephalitis, Herpes Simplex / Q000150:complications / Q000503:physiopathology; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications; D011019:Pneumonia, Mycoplasma / Q000150:complications / Q000503:physiopathology; D012008:Recurrence; D012189:Retrospective Studies; D012640:Seizures / Q000134:cerebrospinal fluid / Q000209:etiology / Q000503:physiopathology*; D013226:Status Epilepticus / Q000134:cerebrospinal fluid / Q000209:etiology / Q000503:physiopathology*; D055815:Young Adult
chemical_list: D000927:Anticonvulsants
keywords: Autoimmune; Encephalitis; Ictal pattern; NMDAr antibodies; Seizure; Status epilepticus