@article{db8a5dabe67444ffb0a82d01b0b1cdc8,
title = "Extreme delta brush; A unique EEG pattern in adults with anti-NMDA receptor encephalitis",
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.",
author = "Schmitt, {Sarah E.} and Kimberly Pargeon and Frechette, {Eric S.} and Hirsch, {Lawrence J.} and Josep Dalmau and Daniel Friedman",
note = "Funding Information: S. Schmitt, K. Pargeon, and E. Frechette report no disclosures. L. Hirsch has received research support from Eisai, Pfizer, UCB-Pharma, Upsher-Smith, and Lundbeck and consultation fees from Lundbeck, Upsher-Smith, and GlaxoSmithKline. J. Dalmau receives royalties from patents for the use of Ma2 and NMDAR as an autoantibody test. Dr. Dalmau has received a research grant from Euroimmun, and his contribution to the current work was supported in part by grants from the National Institutes of Health (R01-NS077851, R01-MH094741), the National Cancer Institute (R01CA89054), Fundaci{\'o} la Marat{\'o} de TV3, and a McKnight Neuroscience of Brain Disorders award. D. Friedman receives salary support from The Epilepsy Study Consortium, a nonprofit organization dedicated to improving the lives of epilepsy patients, and devotes 10% of his time to work done for the Consortium. The Consortium receives payments from a large number of pharmaceutical companies for consulting activities. All payments are made to The Consortium and not to Dr. Friedman directly. Because there are so many companies contributing, the amount from each company towards Dr. Friedman's salary is minimal. Within the past year, the Epilepsy Study Consortium received payments from the 21 companies: Cyberonics, Cypress Biosience, Inc., Eisai Medical Research, Entra Pharmaceuticals, GlaxoSmithKline, Icagen, Inc., Intranasal/Ikano, Johnson & Johnson, Marinus, Neurotherapeutics, NeuroVista Corporation, Ono Pharma USA, Inc., Ovation/Lundbeck, Pfizer, Sepracor, SK Life Science, Supernus Pharmaceuticals, Taro, UCB Inc./Schwarz Pharma, Upsher Smith, and Valeant. All payments are reported annually and reviewed by NYU's Conflict of Interest Committee. Dr. Friedman has served on an advisory board for GlaxoSmithKline. Go to Neurology.org for full disclosures.",
year = "2012",
month = sep,
day = "11",
doi = "10.1212/WNL.0b013e3182698cd8",
language = "English (US)",
volume = "79",
pages = "1094--1100",
journal = "Neurology",
issn = "0028-3878",
publisher = "Lippincott Williams and Wilkins",
number = "11",
}