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Neurology. 2012 Sep 11;79(11):1094-100. doi: 10.1212/WNL.0b013e3182698cd8. Epub 2012 Aug 29.

Extreme delta brush: a unique EEG pattern in adults with anti-NMDA receptor encephalitis.

Author information

  • 1PENN Epilepsy Center, Department of Neurology, Hospital of the University of Pennsylvania, Philadelphia, USA. sarah.schmitt@uphs.upenn.edu

Abstract

OBJECTIVES:

To determine continuous EEG (cEEG) patterns that may be unique to anti-NMDA receptor (NMDAR) encephalitis in a series of adult patients with this disorder.

METHODS:

We evaluated the clinical and EEG data of 23 hospitalized adult patients with anti-NMDAR encephalitis who underwent cEEG monitoring between January 2005 and February 2011 at 2 large academic medical centers.

RESULTS:

Twenty-three patients with anti-NMDAR encephalitis underwent a median of 7 (range 1-123) days of cEEG monitoring. The median length of hospitalization was 44 (range 2-200) days. Personality or behavioral changes (100%), movement disorders (82.6%), and seizures (78.3%) were the most common symptoms. Seven of 23 patients (30.4%) had a unique electrographic pattern, which we named "extreme delta brush" because of its resemblance to waveforms seen in premature infants. The presence of extreme delta brush was associated with a more prolonged hospitalization (mean 128.3 ± 47.5 vs 43.2 ± 39.0 days, p = 0.008) and increased days of cEEG monitoring (mean 27.6 ± 42.3 vs 6.2 ± 5.6 days, p = 0.012). The modified Rankin Scale score showed a trend toward worse scores in patients with the extreme delta brush pattern (mean 4.0 ± 0.8 vs 3.1 ± 1.1, p = 0.089).

CONCLUSIONS:

Extreme delta brush is a novel EEG finding seen in many patients with anti-NMDAR encephalitis. The presence of this pattern is associated with a more prolonged illness. Although the specificity of this pattern is unclear, its presence should raise consideration of this syndrome.

PMID:
22933737
[PubMed - indexed for MEDLINE]
PMCID:
PMC3525298
Free PMC Article

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