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"Burst and slow complexes" in nonconvulsive epileptic status
Akio Ikeda1, Masaru Matsui, Yoshiki Hase
1Department of Neurology, Kyoto University School of Medicine, Japan. akio@kuhp.kyoto-u.ac.jp
Summary
This study observed unique EEG burst-and-slow-wave complexes in a patient with acute disseminated encephalomyelitis (ADEM) and NMDA receptor antibodies. These patterns correlated with enhanced sensory responses during seizures, suggesting an atypical epileptic phenomenon.
Area of Science:
- Neuroscience
- Neurology
- Clinical Neurophysiology
Background:
- Acute disseminated encephalomyelitis (ADEM) is an inflammatory demyelinating disease of the central nervous system.
- Intractable seizures and myoclonus can be presenting symptoms of ADEM.
- Autoimmune encephalitis, particularly anti-NMDA receptor encephalitis, shares overlapping clinical and EEG features with ADEM.
Observation:
- A comatose patient with ADEM presented with generalized convulsions and fragmented myoclonus.
- Atypical generalized 1Hz, burst-and-slow-wave complexes were recorded on EEG.
- Short-latency somatosensory evoked potentials (SEPs) showed a twofold greater N20 amplitude during the burst phase compared to the slow phase of the EEG complexes.
Findings:
- The observed EEG pattern is considered an atypical manifestation of a generalized epileptic phenomenon.
- Enhanced cortical responsiveness to peripheral stimuli during the burst phase of the EEG complexes was suggested by SEP findings.
- Cerebrospinal fluid (CSF) and serum analysis revealed positive autoantibodies to NMDA receptors.
Implications:
- This case highlights a unique EEG pattern in ADEM associated with NMDA receptor autoimmunity.
- The findings suggest a potential link between specific EEG paroxysms and heightened sensory processing during seizures.
- Further research is warranted to understand the pathophysiology and clinical significance of these atypical EEG patterns in autoimmune neurological disorders.