Department of Neurology, Comprehensive Epilepsy Center, Johns Hopkins University, Baltimore, MD, USA.
Clin EEG Neurosci. 2021 Jan;52(1):61-65. doi: 10.1177/1550059420966156. Epub 2020 Oct 14.
Lateralized rhythmic delta activity (LRDA) is a rare pattern on the ictal-interictal continuum (IIC) encountered in critically ill patients. Its association with acute seizures is yet to be fully explored. Insular involvement is a common finding in patients with infectious and autoimmune encephalitis. The association between acute insular lesions and the ictal-interictal continuum, particularly LRDA, has not been explored before.
A case series of 4 patients with either herpetic or autoimmune encephalitis and prominent insular cortex involvement who had LRDA when monitored on continuous EEG is being presented.
Two patients had herpetic encephalitis and 2 patients had autoimmune encephalitis. All patients had either clinical or electrographic seizures with 1 patient progressing into new-onset refractory status epilepticus.
LRDA can be seen in patients with insular cortex acute inflammation. In this group of patients, LRDA may be associated with a higher risk of acute seizures. The presence of this otherwise not clearly epileptiform pattern should raise the clinical suspicion for the development of acute seizures. Patients with LRDA and ipsilateral insular lesions should be carefully monitored for the development of recurrent electrographic or electroclinical seizures and status epilepticus.
在危重病患者的发作-发作间连续体（IIC）上遇到的局灶性节律性 delta 活动（LRDA）是一种罕见的模式。其与急性癫痫发作的关联尚未得到充分探索。岛叶受累是感染性和自身免疫性脑炎患者的常见发现。急性岛叶病变与发作-发作间连续体，特别是 LRDA 之间的关联以前尚未被探索过。
本病例系列包括 4 名具有明显岛叶皮层受累的疱疹性或自身免疫性脑炎患者，他们在连续脑电图监测时出现 LRDA。
2 名患者患有疱疹性脑炎，2 名患者患有自身免疫性脑炎。所有患者均有临床或电发作，其中 1 例进展为新发性难治性癫痫持续状态。
LRDA 可见于岛叶皮层急性炎症患者。在这群患者中，LRDA 可能与急性癫痫发作的风险增加有关。这种非典型癫痫样模式的存在应引起临床对急性癫痫发作发展的怀疑。应密切监测出现 LRDA 和同侧岛叶病变的患者，以发现复发性电或临床癫痫发作和癫痫持续状态。
