Delta Brush Pattern Is Not Unique to NMDAR Encephalitis: Evaluation of Two Independent Long-Term EEG Cohorts

2017 ◽  
Vol 49 (4) ◽  
pp. 278-284 ◽  
Author(s):  
Betul Baykan ◽  
Ozlem Gungor Tuncer ◽  
Ebru Nur Vanli-Yavuz ◽  
Leyla Baysal Kirac ◽  
Gokcen Gundogdu ◽  
...  
Keyword(s):  
Mesial Temporal Lobe Epilepsy ◽  
Good Prognosis ◽  
Icu Patients ◽  
Antineuronal Antibodies ◽  
Aspartate Receptor ◽  
Nmdar Encephalitis ◽  
Delta Activity ◽  
Mesial Temporal Lobe ◽  
Eeg Pattern

Purpose. Although its specificity has not previously been investigated in other cohorts, delta brush pattern (DBP) is increasingly reported in the EEGs of patients with anti- N-methyl-d-aspartate receptor (NMDAR) encephalitis. Methods. We aimed to investigate the DBP in the EEGs of 2 cohorts; patients with change in consciousness for various causes monitored in the intensive care unit (ICU) (n = 106) and patients with mesial temporal lobe epilepsy (MTLE) with or without antineuronal antibodies (n = 76). Results. These patients were investigated for the presence of DBP, defined as an EEG pattern characterized by delta activity at 1 to 3 Hz with superimposed bursts of rhythmic 12- to 30-Hz activity. Two investigators blindfolded for the clinical and immunological data independently analyzed the EEGs for recognition of this pattern. An EEG picture compatible with DBP was observed in 4 patients; only 1 of them (1.3%) belonged to the MTLE group. She did not bear any of the investigated autoantibodies and was seizure-free after epilepsy surgery. In the ICU group, there were 3 additional patients showing DBP with various diagnoses such as hypoxic encephalopathy, brain tumor, stroke, and metabolic derangements. All of them had died in 1-month period. Conclusions. Our results underlined that DBP is not unique to NMDAR encephalitis; it may very rarely occur in MTLE with good prognosis after surgery and second, in ICU patients who have high mortality rate. Therefore, the presence of this pattern should alert the clinician for NMDAR encephalitis but other possible etiologies should not be ignored.

Predictive factors of long-term outcomes of surgery for mesial temporal lobe epilepsy associated with hippocampal sclerosis

Epilepsia ◽  
2017 ◽  
Vol 58 (8) ◽  
pp. 1473-1485 ◽  
Author(s):  
Bertrand Mathon ◽  
Franck Bielle ◽  
Séverine Samson ◽  
Odile Plaisant ◽  
Sophie Dupont ◽  
...  
Keyword(s):  
Temporal Lobe Epilepsy ◽  
Temporal Lobe ◽  
Predictive Factors ◽  
Hippocampal Sclerosis ◽  
Mesial Temporal Lobe Epilepsy ◽  
Long Term Outcomes ◽  
Mesial Temporal Lobe

scholarly journals Mesial temporal lobe epilepsy: long-term seizure outcome of patients primarily treated with transsylvian selective amygdalohippocampectomy

2018 ◽  
Vol 129 (1) ◽  
pp. 174-181 ◽  
Author(s):  
Christian Dorfer ◽  
Thomas Czech ◽  
Susanne Aull-Watschinger ◽  
Christoph Baumgartner ◽  
Rebekka Jung ◽  
...  
Keyword(s):  
Temporal Lobe Epilepsy ◽  
Temporal Lobe ◽  
Mesial Temporal Lobe Epilepsy ◽  
Class I ◽  
Seizure Outcome ◽  
Selective Amygdalohippocampectomy ◽  
Class 1 ◽  
Mesial Temporal Lobe

OBJECTIVEThe aim of this study was to present long-term seizure outcome data in a consecutive series of patients with refractory mesial temporal lobe epilepsy primarily treated with transsylvian selective amygdalohippocampectomy (SAHE).METHODSThe authors retrospectively analyzed prospectively collected data for all patients who had undergone resective surgery for medically refractory epilepsy at their institution between July 1994 and December 2014. Seizure outcome was assessed according to the International League Against Epilepsy (ILAE) and the Engel classifications.RESULTSThe authors performed an SAHE in 158 patients (78 males, 80 females; 73 right side, 85 left side) with a mean age of 37.1 ± 10.0 years at surgery. Four patients lost to follow-up and 1 patient who committed suicide were excluded from analysis. The mean follow-up period was 9.7 years. At the last available follow-up (or before reoperation), 68 patients (44.4%) had achieved an outcome classified as ILAE Class 1a, 46 patients (30.1%) Class 1, 6 patients (3.9%) Class 2, 16 patients (10.4%) Class 3, 15 patients (9.8%) Class 4, and 2 patients (1.3%) Class 5. These outcomes correspond to Engel Class I in 78.4% of the patients, Engel Class II in 10.5%, Engel Class III in 8.5%, and Engel Class IV in 2.0%. Eleven patients underwent a second surgery (anterior temporal lobectomy) after a mean of 4.4 years from the SAHE (left side in 6 patients, right side in 5). Eight (72.7%) of these 11 patients achieved seizure freedom.The overall ILEA seizure outcome since (re)operation after a mean follow-up of 10.0 years was Class 1a in 72 patients (47.0%), Class 1 in 50 patients (32.6%), Class 2 in 7 patients (4.6%), Class 3 in 15 patients (9.8%), Class 4 in 8 patients (5.2%), and Class 5 in 1 patient (0.6%). These outcomes correspond to an Engel Class I outcome in 84.3% of the patients.CONCLUSIONSA satisfactory long-term seizure outcome following transsylvian SAHE was demonstrated in a selected group of patients with refractory temporal lobe epilepsy.

scholarly journals The use of radiosurgery for the treatment of mesial temporal lobe epilepsy and long-term results

Epilepsia ◽  
2009 ◽  
Vol 50 (9) ◽  
pp. 2061-2071 ◽  
Author(s):  
Zdeněk Vojtěch ◽  
Vilibald Vladyka ◽  
Miroslav Kalina ◽  
Evžen Nešpor ◽  
Kateřina Seltenreichová ◽  
...  
Keyword(s):  
Temporal Lobe Epilepsy ◽  
Temporal Lobe ◽  
Mesial Temporal Lobe Epilepsy ◽  
Long Term Results ◽  
Mesial Temporal Lobe

Drug Treatment of Epilepsy: When Does It Fail and How to Optimize Its Use?

CNS Spectrums ◽  
2004 ◽  
Vol 9 (2) ◽  
pp. 110-119 ◽  
Author(s):  
Patrick Kwan ◽  
Martin J. Brodie
Keyword(s):  
Mesial Temporal Lobe Epilepsy ◽  
Epilepsy Syndrome ◽  
Combination Regimen ◽  
First Line ◽  
Community Based ◽  
Early Use ◽  
History Of ◽  
Mesial Temporal Lobe ◽  
History Of Epilepsy

AbstractAlthough modern community-based studies have shown that a majority of people with newly diagnosed epilepsy will enter long-term remission, seizures remain refractory to treatment in a substantial proportion of this population—perhaps as much as 40%. A consensus is being reached that, for operational purposes, pharmacoresistance can be suspected when two appropriately chosen, well-tolerated, first-line antiepileptic drugs (AEDs) or one monotherapy and one combination regimen have failed due to lack of efficacy. Poor prognostic factors include lack of response to the first AED, specific syndromes, symptomatic etiology, family history of epilepsy, psychiatric comorbidity, and high frequency of seizures. These observations suggest that prognosis can often be determined early in the course of the disorder. We propose a management paradigm that aims to maximize the chance of successful AED therapy, including the early use of “rational polytherapy” for patients not responding to monotherapy, and to identify efficiently patients suitable for “curative” resective surgery, in particular those with mesial temporal lobe epilepsy. An orderly approach to each epilepsy syndrome will optimize the chance of perfect seizure control and help more patients achieve a fulfilling life.

Long-term outcome of mild mesial temporal lobe epilepsy

Neurology ◽  
2016 ◽  
Vol 86 (20) ◽  
pp. 1904-1910 ◽  
Author(s):  
Angelo Labate ◽  
Umberto Aguglia ◽  
Giovanni Tripepi ◽  
Laura Mumoli ◽  
Edoardo Ferlazzo ◽  
...  
Keyword(s):  
Temporal Lobe Epilepsy ◽  
Temporal Lobe ◽  
Mesial Temporal Lobe Epilepsy ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Mesial Temporal Lobe

scholarly journals A critical reflection on our first patient presenting with Anti-Nmethyl- D-aspartate receptor encephalitis

2019 ◽  
Vol 11 (3) ◽  
Author(s):  
Susanne Buechner ◽  
Igor Florio ◽  
Gabriele J. Sixt ◽  
Francesco Teatini
Keyword(s):  
Treatment Guidelines ◽  
Autoimmune Encephalitis ◽  
Complete Recovery ◽  
Intravenous Immunoglobulins ◽  
High Dose ◽  
Aspartate Receptor ◽  
Nmdar Encephalitis ◽  
One Year

One of the best characterized autoimmune encephalitis is the Anti-Nmethyl-D-aspartate receptor (NMDAR) encephalitis, which may occur in the presence of cancer. First- and second-line immunotherapy and oncological investigations are suggested. We present here a case of an 18-year-old female who was our first patient suffering from Anti-NMDAR encephalitis more than 9 years ago. She was satisfactorily treated with intravenous immunoglobulins and high dose steroid therapy. After more than one year the patient had a relapse. First-line immunotherapy was repeated; however, a complete recovery was achieved only after plasmapheresis. Afterwards, she continued maintenance immunotherapy with steroids for two years and with Azathioprine for about five years associated to regular oncological assessment. In the last years our therapeutical approach of Anti-NMDARencephalitis has significantly changed. Nevertheless, established treatment guidelines are still missing and the role of long-term maintenance immunotherapy is largely unexplored. In addition, oncological revaluation might be indicated in selected patients.

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