Analysis of autoimmune encephalitis seizure types and EEG characteristics_Journal of Epilepsy

Authors：

 YUJinbei , WANGZan ,  LINWeihong

Department of Neurology, Epilepsy Center, First Hospital of Jilin University, Changchun 130021, Jilin, China;

Corresponding?author：

LINWeihong, Email: Linweihong321@126.com

Keywords：

Autoimmune encephalitis; EEG; Seizure type

DOI：

10.7507/2096-0247.20150020

Video：

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Objective The purpose of this study was to investigate the autoimmune encephalitis (AE) seizure types and EEG characteristics and the value of diagnosis. Methods Fifteen AE patients were hospitalized in the Department of Neurology at the First Hospital of Jilin University from November 2012 to July 2014. Data from their clinical manifestations, seizure types, EEG characteristics and laboratory investigation were analyzed. Result A total of 15 patients, 5 males and 10 females, aged 19-75 years were included. Eight cases of anti-NMDA receptor encephalitis, five cases of LGI1 receptor encephalitis and two cases of anti-Hu antibody encephalitis were diagnosed clinically.①Anti-NMDA receptor encephalitis:seven patients had seizures, which inclued complex partial seizure, generalized tonic-clonic seizure, simple partial seizure and status epilepticus.Three patients had extreme delta brush.②LGI1 receptor encephalitis:two cases had seizures, while four cases with FBDS. Sharp and slow waves with irregular delta waves appeared in bilateral temporal areas in EEG of three cases, while one case showed clinical seizure. Two cases detected "limb shaking and others" attack, but the corresponding EEG showed no abnormalities.③Anti-Hu antibody encephalitis:one case showed seizures, the EEG showed a lot of sharp and slow waves with irregular delta waves in bilateral temporal areas, while one case showed sharp and slow waves. Conclusion Anti-NMDA receptor encephalitis can present with various types of seizures and non-convulsive status epilepticus, interictal extreme delta brush is more specific. It has important value. LGI1 receptor encephalitis is characterized by FBDS, it has important clinical significance.Anti-Hu antibody encephalitis lesions diffuse distribution, clinical manifestations are different. It may be associated with seizures, seizure types are not-specific.It may have slow waves or sharp and slow waves.

Citation： YUJinbei, WANGZan, LINWeihong. Analysis of autoimmune encephalitis seizure types and EEG characteristics. Journal of Epilepsy, 2015, 1(2): 132-138. doi: 10.7507/2096-0247.20150020 Copy

1.	王得新, 劉磊.自身免疫性腦炎現代概念與分類.中國實用內科雜志, 2012, 32(11):824-825.
2.	Demaerel P, Van Dessel W, Van Paesschen W, et al. Autoimmune mediated encephalitis. Neuroradiology, 2011, 53(11):837-851.
3.	Schmitt SE, Pargeon K, Frechette ES, et al. Extreme delta brush:A unique EEG pattern in adults with anti-NMDA receptor encephalitis. Neurology, 2012, 79(14):1094-1100.
4.	Vincent A, Bien CG, Irani SR, et al. Autoantibodies associated with diseases of the CNS:new developments and future challenges. Lancet Neurol, 2011, 10(7):759-772.
5.	Lalic T, Pettingill P, Vincent A, et al. Human limbic encephalitis serum enhances hippocampal mossy fiber-CA3 pyramidal cell synaptic transmission. Epilepsia, 2010, 52(12):121-131.
6.	Irani SR, Michell AW, Lang B, et al. Faciobraehial dystonic seizures precede Lgi-l antibody limbic encephalitis. Ann Neurol, 2011, 69(22):892-900.
7.	Kotagal P, Luders H, Morris HH, et al. Dystonic posturing in complex partial seizures of temporal lobe onset:a new lateralizing sign. Neurology, 1989, 39(12):196-201.
8.	Bleasel A, Kotagal P, Kankirawatana P, et al. Later aliving value and semiology of ictal limb posturing and version in temporal lobe and extra temporal epilepsy. Epilepsia, 1997, 38(6):168-174.
9.	任海濤, 趙燕環, 關鴻志, 等.抗Hu抗體檢測在神經系統副腫瘤綜合征診斷中的臨床意義.中國神經免疫學與神經病學雜志, 2011, 18(5):332-335.
10.	Sillevis Smitt P, Grefkens J, de Leeuw B, et al. Survival and outcome in 73 anti-Hu positive patients with paraneoplastic encephalomyelitis/sensory neuronopathy. J Neurol, 2002, 249(6):745-753.

1. 王得新, 劉磊.自身免疫性腦炎現代概念與分類.中國實用內科雜志, 2012, 32(11):824-825.
2. Demaerel P, Van Dessel W, Van Paesschen W, et al. Autoimmune mediated encephalitis. Neuroradiology, 2011, 53(11):837-851.
3. Schmitt SE, Pargeon K, Frechette ES, et al. Extreme delta brush:A unique EEG pattern in adults with anti-NMDA receptor encephalitis. Neurology, 2012, 79(14):1094-1100.
4. Vincent A, Bien CG, Irani SR, et al. Autoantibodies associated with diseases of the CNS:new developments and future challenges. Lancet Neurol, 2011, 10(7):759-772.
5. Lalic T, Pettingill P, Vincent A, et al. Human limbic encephalitis serum enhances hippocampal mossy fiber-CA3 pyramidal cell synaptic transmission. Epilepsia, 2010, 52(12):121-131.
6. Irani SR, Michell AW, Lang B, et al. Faciobraehial dystonic seizures precede Lgi-l antibody limbic encephalitis. Ann Neurol, 2011, 69(22):892-900.
7. Kotagal P, Luders H, Morris HH, et al. Dystonic posturing in complex partial seizures of temporal lobe onset:a new lateralizing sign. Neurology, 1989, 39(12):196-201.
8. Bleasel A, Kotagal P, Kankirawatana P, et al. Later aliving value and semiology of ictal limb posturing and version in temporal lobe and extra temporal epilepsy. Epilepsia, 1997, 38(6):168-174.
9. 任海濤, 趙燕環, 關鴻志, 等.抗Hu抗體檢測在神經系統副腫瘤綜合征診斷中的臨床意義.中國神經免疫學與神經病學雜志, 2011, 18(5):332-335.
10. Sillevis Smitt P, Grefkens J, de Leeuw B, et al. Survival and outcome in 73 anti-Hu positive patients with paraneoplastic encephalomyelitis/sensory neuronopathy. J Neurol, 2002, 249(6):745-753.

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