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Dynamics of sleep-wake cycles and architecture in anti-NMDAR encephalitis
Lina Jeantin1, Louis Cousyn1, Vincent Navarro1
1AP-HP, Pitié-Salpêtrière Hospital, Epilepsy Unit, Paris, France; Sorbonne Université, Paris Brain Institute - ICM, Inserm, CNRS, APHP, Hôpital de la Pitié-Salpêtrière, Paris, France; Center of Reference for Rare Epilepsies, ERN EPICARE, Pitié-Salpêtrière Hospital, Paris, France.
Abstract:
Sleep disturbances in anti-NMDAR encephalitis evolve dynamically across disease phases. We monitored a patient longitudinally from the acute phase through remission, relapse, and recovery, using video-EEG and polysomnography. No sleep complaints were reported during the prodromal phase, whereas coma was characterized by rhythmic theta-delta activity devoid of sleep patterns. Sleep stages gradually emerged after teratoma removal and immunotherapy, paralleling clinical improvement. A second teratoma caused relapse with severe sleep disruption and agrypnia excitata, then residual status dissociatus persisted before normalization. Sleep changes mirrored disease progression, suggesting that sleep patterns may serve as biomarkers and potential therapeutic targets in anti-NMDAR encephalitis.
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