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. 2021 Dec:178:106787.
doi: 10.1016/j.eplepsyres.2021.106787. Epub 2021 Oct 22.

Electroencephalography characteristics to predict one-year outcomes in pediatric anti-NMDA receptor encephalitis

Jenny Lin  1 , Kathryn Elkins  1 , Sonam Bhalla  2 , Satyanarayana Gedela  2 , Ammar Kheder  2 , Guojun Zhang  2 , Leah Loerinc  3 , Laura Blackwell  4 , Robyn Howarth  4 , Grace Gombolay  5
Affiliations

Electroencephalography characteristics to predict one-year outcomes in pediatric anti-NMDA receptor encephalitis

Jenny Lin et al. Epilepsy Res. 2021 Dec.

Abstract

Background: Electrographic characteristics (extreme delta brush, posterior dominant rhythm and slow waves) may predict outcomes in anti-NMDA receptor encephalitis (NMDARE). However, whether changes in EEG sleep architecture predict outcomes are unknown. We examine electrophysiological characteristics including sleep architecture in a pediatric NMDARE population and correlate with outcomes at one year.

Methods: Retrospective chart and EEG review was performed in pediatric NMDARE patients at a single center. Patients with first EEGs available within 48 h of admission, prior to treatment, and one-year follow-up data were included. EEGs were independently reviewed by two epileptologists, and a third when disagreement occurred. Clinical outcomes included modified Rankin scale (mRS) at one year.

Results: Nine patients (6 females) (range 1.9-16.7 years) were included. Five of nine patients had loss of posterior dominant rhythm (PDR) and three of nine patients had absent sleep architecture. Loss of PDR correlated with a worse mRS score at one year (2.8 versus 0.5, p = 0.038). Loss of PDR and loss of sleep architecture was associated with increased inpatient rehabilitation stay and in higher number of immunotherapy treatments administered. In multivariate analysis, absence of sleep architecture (p = 0.028), absence of PDR (p = 0.041), and epileptiform discharges (p = 0.041) were predictors of mRS at one year.

Conclusions: Loss of normal PDR, absence of sleep architecture, and epileptiform discharges are associated with worse outcomes at one year which has not been reported before. EEG characteristics may help prognosticate in NMDARE. Larger studies are needed to confirm these findings.

Keywords: Anti-NMDA receptor encephalitis; Delta brush; EEG; Electroencephalography; Pediatric; Sleep.

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Figures

Fig. 1.
Fig. 1.
Representative electroencephalography (EEG) characteristics from anti-NMDA receptor encephalitis patients in standard bipolar montage with sensitivity at 7 microvolts and time base of 30 mm per second. A. Depicts sleep stages: N1 with vertex waves, N2 with sleep spindles and vertex waves, N3 with slow wave sleep and REM. B. Example of normal awake background with posterior dominant rhythm of 8–9 Hertz. C. Example of diffuse delta brush, with prominent delta waves with overlying lower amplitude beta activity in the bifrontal leads, highlighted by the red box.
Fig. 2.
Fig. 2.
The effects of posterior dominant rhythm (PDR) and sleep architecture on inpatient rehabilitation length of stay (LOS, A) and number of immunotherapies administered (B). *indicates p < 0.05.
See this image and copyright information in PMC

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