Farooqi Ashar M, Sawalha Ahmad, Omidi Shirin Jamal, Dubey Divyanshu, Britton Jeffrey, Smith Kelsey M
Department of Neurology, Mayo Clinic, Rochester, MN, 55905, USA.
Department of Neurology, University of Kentucky College of Medicine, Lexington, KY, USA.
J Neurol. 2025 Jan 7;272(1):95. doi: 10.1007/s00415-024-12862-8.
Seizures, including status epilepticus (SE), are common in anti-NMDA receptor encephalitis (NMDARE). We aimed to describe clinical and electrographic features of patients with seizures with NMDARE, determine factors associated with SE, and describe long-term seizure outcomes.
We retrospectively identified patients with seizures in the setting of NMDARE treated at inpatient Mayo Clinic sites during the acute phase of encephalitis between October 2008 and March 2023. Seizure semiology, clinical symptoms, electrographic features, neuroimaging, treatment course, complications, and outcome were abstracted. We compared clinical features between patients with and without SE.
We identified 29 patients with seizures during acute NMDARE. Temporal onset was the most common EEG localization (n = 14, 48.3%). Subclinical seizures were recorded in 15 (51.7%). Twelve (41.4%) patients had SE, which was associated with temporal T2-signal hyperintensity, seizures with unilateral clonic and/or tonic movements, multiple seizure foci on EEG, temporal and midline/central onset seizures, higher acute CASE scores, intensive care unit (ICU) admission, longer length of hospitalization, and need for post-hospitalization rehabilitation. One patient (3.4%) died during the acute encephalitis. One patient (3.4%) developed chronic epilepsy. The remaining patients were seizure-free at the last follow-up (median 23 months, range 2-163 months). SE was not associated with differences in outcome at last follow-up.
Seizures in NMDARE are frequently temporal onset. SE is common and associated with higher likelihood of ICU level care, longer hospitalization, and higher need for post-hospital rehabilitation. Despite the significant short-term impact of SE, long-term outcome was not affected, and seizure prognosis was favorable.
癫痫发作，包括癫痫持续状态（SE），在抗N-甲基-D-天冬氨酸受体脑炎（NMDARE）中很常见。我们旨在描述NMDARE癫痫患者的临床和脑电图特征，确定与SE相关的因素，并描述癫痫的长期预后。
我们回顾性地确定了2008年10月至2023年3月脑炎急性期在梅奥诊所住院治疗的NMDARE患者中的癫痫患者。提取癫痫发作的症状学、临床症状、脑电图特征、神经影像学、治疗过程、并发症和预后。我们比较了有SE和无SE患者的临床特征。
我们确定了29例急性NMDARE期间癫痫发作的患者。颞叶发作是最常见的脑电图定位（n = 14，48.3%）。15例（51.7%）记录到亚临床发作。12例（41.4%）患者发生SE，这与颞叶T2信号高增强、伴有单侧阵挛和/或强直运动的发作、脑电图上多个癫痫病灶、颞叶和中线/中央发作、更高的急性CASE评分、重症监护病房（ICU）入院、更长的住院时间以及住院后康复需求相关。1例患者（3.4%）在急性脑炎期间死亡。1例患者（3.4%）发展为慢性癫痫。其余患者在最后一次随访时无癫痫发作（中位时间23个月，范围2 - 至163个月）。SE与最后一次随访时的预后差异无关。
NMDARE中的癫痫发作常为颞叶发作。SE很常见，且与更高的ICU级护理可能性、更长的住院时间以及更高的住院后康复需求相关。尽管SE有显著的短期影响，但长期预后未受影响，癫痫预后良好。
