Extreme delta brush; A unique EEG pattern in adults with anti-NMDA receptor encephalitis

Sarah E. Schmitt, Kimberly Pargeon, Eric S. Frechette, Lawrence J. Hirsch, Josep Dalmau, Daniel Friedman

Research output: Contribution to journalArticle

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.

Original languageEnglish (US)
Pages (from-to)1094-1100
Number of pages7
JournalNeurology
Volume79
Issue number11
DOIs
StatePublished - Sep 11 2012
Externally publishedYes

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Anti-N-Methyl-D-Aspartate Receptor Encephalitis
Electroencephalography
Hospitalization
Movement Disorders
Premature Infants
Personality
Electroencephalogram
Seizures

ASJC Scopus subject areas

  • Clinical Neurology
  • Arts and Humanities (miscellaneous)

Cite this

Schmitt, S. E., Pargeon, K., Frechette, E. S., Hirsch, L. J., Dalmau, J., & Friedman, D. (2012). Extreme delta brush; A unique EEG pattern in adults with anti-NMDA receptor encephalitis. Neurology, 79(11), 1094-1100. https://doi.org/10.1212/WNL.0b013e3182698cd8

Extreme delta brush; A unique EEG pattern in adults with anti-NMDA receptor encephalitis. / Schmitt, Sarah E.; Pargeon, Kimberly; Frechette, Eric S.; Hirsch, Lawrence J.; Dalmau, Josep; Friedman, Daniel.

In: Neurology, Vol. 79, No. 11, 11.09.2012, p. 1094-1100.

Research output: Contribution to journalArticle

Schmitt, SE, Pargeon, K, Frechette, ES, Hirsch, LJ, Dalmau, J & Friedman, D 2012, 'Extreme delta brush; A unique EEG pattern in adults with anti-NMDA receptor encephalitis', Neurology, vol. 79, no. 11, pp. 1094-1100. https://doi.org/10.1212/WNL.0b013e3182698cd8
Schmitt SE, Pargeon K, Frechette ES, Hirsch LJ, Dalmau J, Friedman D. Extreme delta brush; A unique EEG pattern in adults with anti-NMDA receptor encephalitis. Neurology. 2012 Sep 11;79(11):1094-1100. https://doi.org/10.1212/WNL.0b013e3182698cd8
Schmitt, Sarah E. ; Pargeon, Kimberly ; Frechette, Eric S. ; Hirsch, Lawrence J. ; Dalmau, Josep ; Friedman, Daniel. / Extreme delta brush; A unique EEG pattern in adults with anti-NMDA receptor encephalitis. In: Neurology. 2012 ; Vol. 79, No. 11. pp. 1094-1100.
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