Department of Pediatric Neurology, Children's Healthcare of Atlanta, Atlanta, GA, USA; Emory University School of Medicine, Atlanta, GA, USA.
Department of Pediatric Neurology, Children's Healthcare of Atlanta, Atlanta, GA, USA; Emory University School of Medicine, Department of Pediatrics, Division of Neurology Atlanta, GA, USA.
Epilepsy Res. 2021 Dec;178:106787. doi: 10.1016/j.eplepsyres.2021.106787. Epub 2021 Oct 22.
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.
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.
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.
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.
电描记特征（极度德尔塔刷、后优势节律和慢波）可能预测抗 N-甲基-D-天冬氨酸受体脑炎（NMDARE）的结局。然而，脑电图睡眠结构的变化是否能预测结局尚不清楚。我们研究了包括睡眠结构在内的电生理特征，并与一年后的结果进行了相关性分析。
在一家单中心对儿科 NMDARE 患者进行回顾性图表和脑电图复查。纳入在入院后 48 小时内、治疗前和一年随访时具有首次脑电图的患者。由两位癫痫专家独立对脑电图进行复查，出现分歧时由第三位专家复查。临床结局包括一年时的改良 Rankin 量表（mRS）评分。
纳入 9 名患者（6 名女性）（年龄 1.9-16.7 岁）。9 名患者中有 5 名存在后优势节律丧失，3 名患者存在睡眠结构缺失。后优势节律丧失与一年时 mRS 评分更差相关（2.8 分比 0.5 分，p=0.038）。后优势节律丧失和睡眠结构缺失与住院康复时间延长和免疫治疗次数增加相关。多变量分析显示，睡眠结构缺失（p=0.028）、后优势节律丧失（p=0.041）和癫痫样放电（p=0.041）是一年时 mRS 的预测因素。
正常后优势节律丧失、睡眠结构缺失和癫痫样放电与一年时的不良结局相关，这在以前的研究中尚未报道过。脑电图特征可能有助于预测 NMDARE 的结局。需要更大的研究来证实这些发现。
