Extreme Delta Brush in Anti-NMDAR Encephalitis Correlates With Poor Functional Outcome and Death

Area of Science:

• Neuroscience
• Neurology
• Clinical Neurophysiology

Background:

• Anti-N-methyl-D-aspartate receptor (anti-NMDAR) encephalitis is a severe autoimmune neurological disorder.
• Electroencephalogram (EEG) is crucial for diagnosing and monitoring neurological conditions.
• The significance of specific EEG patterns, like extreme delta brush (EDB), in anti-NMDAR encephalitis requires further elucidation.

Purpose of the Study:

• To characterize EEG findings in patients diagnosed with anti-NMDAR encephalitis.
• To determine the prevalence of abnormal EEGs and the specific pattern of extreme delta brush (EDB).
• To correlate EEG findings with clinical outcomes, including Glasgow Outcome Scale (GOS) at 6 months, ICU admission, and mortality.

Main Methods:

• Retrospective cohort study including 21 patients with anti-NMDAR encephalitis from 2014 to 2021.
• Analysis of 64 EEGs by two independent reviewers.
• Extraction of clinical outcome data (GOS, ICU admission, death) via chart review.

Main Results:

• Only 6.3% of EEGs were normal; 68.8% showed slowing, and 25.0% exhibited EDB.
• EDB was present in 42.9% of patients.
• EDB significantly correlated with increased ICU admission (p=0.02), poorer 6-month GOS (p=0.002), and mortality (p=0.02).

Conclusions:

• Abnormal EEG findings are common in anti-NMDAR encephalitis.
• The presence of EDB on EEG is a significant predictor of severe clinical outcomes.
• EDB is associated with a higher likelihood of ICU admission, worse functional recovery, and increased risk of death in anti-NMDAR encephalitis.