Moreno-Avellán Alvaro, Juarez-Jaramillo Arely, Fernandez Gonzalez-Aragon Maria Del Carmen, Quiñones-Pesqueira Gerardo, Pineda-Centeno Luz Maria, Espinola-Nadurille Mariana, Martinez-Angeles Victoria, Martinez-Carrillo Francisco, Rivas-Alonso Veronica, San-Juan Daniel, Flores-Rivera Jose, Ramirez-Bermudez Jesus
The Department of Clinical Neurophysiology, National Institute of Neurology and Neurosurgery, Insurgentes sur 3877, Ciudad de Mexico 14269, Mexico.
Neuropsychiatry Unit, National Institute of Neurology and Neurosurgery, Insurgentes sur 3877, Ciudad de Mexico 14269, Mexico.
Diagnostics (Basel). 2025 Apr 29;15(9):1131. doi: 10.3390/diagnostics15091131.
Anti-NMDA receptor encephalitis is an autoimmune disease characterized by severe neuropsychiatric disturbances, often misdiagnosed as a primary psychiatric disorder. Early diagnosis is crucial, as delayed immunotherapy is associated with worse outcomes. Electroencephalography (EEG) is a widely available tool for detecting abnormalities that may aid in early detection of cases that should undergo a thorough approach. Although EEG has high sensitivity, its specificity remains a challenge. This case-control study was carried out in the National Institute of Neurology and Neurosurgery of Mexico and included 241 patients with acute or subacute neuropsychiatric disturbances, raising the suspicion of autoimmune encephalitis and leading to the determination of NMDA receptor antibodies in the cerebrospinal fluid (CSF). EEG patterns were analyzed to determine the frequency of abnormal findings and their diagnostic value. 140 patients were diagnosed as having definite anti-NMDA receptor encephalitis, whereas 101 had a negative determination of NMDA receptor antibodies. Psychosis was very frequent in both groups. However, severe cognitive dysfunction and catatonia were significantly more frequent in anti-NMDA receptor encephalitis patients. EEG abnormalities were significantly more frequent in patients with anti-NMDA receptor encephalitis patients (87.2% vs. 61.2%, < 0.001). Diffuse slowing (75.7% vs. 46.6%, < 0.001) and the extreme delta brush pattern (8.8% vs. 0%, OR = 20.6, = 0.002) were significantly associated with anti-NMDA receptor encephalitis. Logistic regression analysis confirmed that an abnormal EEG remained strongly associated with anti-NMDA receptor encephalitis after adjusting for confounders. EEG abnormalities, particularly diffuse slowing and the extreme delta brush pattern, provide important diagnostic clues in patients with a clinical suspicion of anti-NMDA receptor encephalitis. While EEG has high sensitivity, its specificity is enhanced by recognizing distinct patterns. These findings support the integration of EEG into diagnostic algorithms to guide early detection and management of autoimmune encephalitis.
抗N-甲基-D-天冬氨酸（NMDA）受体脑炎是一种自身免疫性疾病，其特征为严重的神经精神障碍，常被误诊为原发性精神障碍。早期诊断至关重要，因为延迟免疫治疗与更差的预后相关。脑电图（EEG）是一种广泛可用的工具，用于检测可能有助于早期发现应接受全面检查病例的异常情况。虽然EEG具有高敏感性，但其特异性仍然是一个挑战。本病例对照研究在墨西哥国家神经病学和神经外科学研究所进行，纳入了241例急性或亚急性神经精神障碍患者，这些患者因怀疑自身免疫性脑炎而进行了脑脊液（CSF）中NMDA受体抗体的检测。分析EEG模式以确定异常发现的频率及其诊断价值。140例患者被诊断为确诊的抗NMDA受体脑炎，而101例患者的NMDA受体抗体检测为阴性。两组中精神病都很常见。然而，严重认知功能障碍和紧张症在抗NMDA受体脑炎患者中明显更常见。抗NMDA受体脑炎患者的EEG异常明显更常见（87.2%对61.2%，<0.001）。弥漫性减慢（75.7%对46.6%，<0.001）和极慢波刷状模式（8.8%对0%，OR=20.6，=0.002）与抗NMDA受体脑炎显著相关。逻辑回归分析证实，在调整混杂因素后，异常EEG仍然与抗NMDA受体脑炎密切相关。EEG异常，特别是弥漫性减慢和极慢波刷状模式，为临床怀疑抗NMDA受体脑炎的患者提供了重要的诊断线索。虽然EEG具有高敏感性，但通过识别不同模式可提高其特异性。这些发现支持将EEG纳入诊断算法，以指导自身免疫性脑炎的早期检测和管理。
