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Journal of Pediatric Epilepsy 2021; 10(01): 013-021
DOI: 10.1055/s-0040-1718723
Original Article

Electroencephalographic Findings in Pediatric Patients with Anti-N-Methyl-D-Aspartate Receptor Encephalitis: The San Diego Experience

Aliya Frederick
1   Division of Child Neurology, University of California San Diego and Rady Children's Hospital, San Diego, California, United States
2   Department of Neurology, University of California San Diego, San Diego, California, United States
,
Jennifer H. Yang
1   Division of Child Neurology, University of California San Diego and Rady Children's Hospital, San Diego, California, United States
2   Department of Neurology, University of California San Diego, San Diego, California, United States
,
Natalie Guido-Estrada
1   Division of Child Neurology, University of California San Diego and Rady Children's Hospital, San Diego, California, United States
2   Department of Neurology, University of California San Diego, San Diego, California, United States
,
Jose Soria-Lopez
2   Department of Neurology, University of California San Diego, San Diego, California, United States
,
Shifteh Sattar
1   Division of Child Neurology, University of California San Diego and Rady Children's Hospital, San Diego, California, United States
2   Department of Neurology, University of California San Diego, San Diego, California, United States
› Author Affiliations
Funding None.
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Abstract

Diagnosing anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis clinically can be challenging. There is a growing interest in identifying specific electroencephalographic features to help guide early management. A retrospective chart review was conducted of pediatric patients admitted to Rady Children's Hospital between January 1, 2010 and April 1, 2017. We included patients with the diagnosis of encephalitis who underwent continuous video electroencephalogram (VEEG) for at least 12 hours, and presented with less than 14 days of symptoms. We compared the electroencephalographic features of non-rapid eye movement (NREM) sleep between patients with antibody confirmed anti-NMDAR encephalitis and patients with encephalitis from other etiologies. We identified seven patients who met our inclusion criteria, five of whom were diagnosed with anti-NMDAR encephalitis. Four of the five patients had a significant reduction in NREM sleep, while one patient had increased NREM sleep associated with clinical catatonia and hypersomnolence. Sleep was preserved in the two cases of nonimmune mediated encephalitis. Our results suggest that a prolonged VEEG to capture sleep coupled with clinical features can aid in early diagnosis and treatment of anti-NMDAR encephalitis, often before confirmatory antibody testing is available.

Keywords

anti-NMDA receptor encephalitis - anti-NMDAR encephalitis - electroencephalogram - NREM sleep


Publication History

Received: 08 July 2020

Accepted: 10 September 2020

Article published online:
02 November 2020

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