title: Auditory seizures in autoimmune epilepsy: a case with anti-thyroid antibodies.
abstract: In its classic presentation, Hashimoto's encephalopathy is an acute-subacute complex neuropsychiatric syndrome with cognitive impairment, hallucinations, myoclonus, tremor or ataxia, associated with elevated anti-thyroid antibodies. Corticoids and immunotherapy are dramatically effective. However, in some cases, not all the associated features are presented and this delays diagnosis and appropriate treatment. We describe a man with abrupt onset of recurrent auditory seizures resulting in refractory non-convulsive status epilepticus. The patient was diagnosed with an autoimmune encephalopathy with elevated serum and CSF anti-thyroid antibodies. None of the antiepileptic drugs were successful, however, following immune-modulating therapy, the refractory non-convulsive status epilepticus dramatically improved, as did the patient overall. We suggest that Hashimoto's encephalopathy should be suspected in otherwise healthy patients with unexplained new-onset focal recurrent auditory seizures which do not respond to antiepileptic drugs. The presence of anti-thyroid antibodies in the CSF supports this diagnosis.
authors.affiliation: Gionata Strigaro Department of Translational Medicine, Section of Neurology, University of Piemonte Orientale, Novara.
authors.forename: Claudia
authors.initials: C
authors.lastname: Varrasi
authors.affiliation: Gionata Strigaro Department of Translational Medicine, Section of Neurology, University of Piemonte Orientale, Novara.
authors.forename: Domizia
authors.initials: D
authors.lastname: Vecchio
authors.affiliation: Gionata Strigaro Department of Translational Medicine, Section of Neurology, University of Piemonte Orientale, Novara.
authors.forename: Luca
authors.initials: L
authors.lastname: Magistrelli
authors.affiliation: Gionata Strigaro Department of Translational Medicine, Section of Neurology, University of Piemonte Orientale, Novara, CRRF Mons. L. Novarese, Neurorehabilitation Unit, Moncrivello, VC.
authors.forename: Gionata
authors.initials: G
authors.lastname: Strigaro
authors.affiliation: "C. Munari" Epilepsy Surgery Centre, Niguarda Hospital, Milan.
authors.forename: Laura
authors.initials: L
authors.lastname: Tassi
authors.affiliation: Gionata Strigaro Department of Translational Medicine, Section of Neurology, University of Piemonte Orientale, Novara.
authors.forename: Roberto
authors.initials: R
authors.lastname: Cantello
mesh_terms: D001323:Autoantibodies / Q000134:cerebrospinal fluid; D000069279:Drug Resistant Epilepsy / Q000209:etiology*; D004660:Encephalitis / Q000134:cerebrospinal fluid* / Q000150:complications*; D006212:Hallucinations / Q000209:etiology*; D050031:Hashimoto Disease / Q000134:cerebrospinal fluid* / Q000150:complications*; D006801:Humans; D008297:Male; D008875:Middle Aged; D013226:Status Epilepticus / Q000209:etiology*
chemical_list: D001323:Autoantibodies
keywords: Hashimoto's encephalopathy; anti-thyroid antibodies; autoimmune encephalopathy; status epilepticus