Electroencephalography characteristics to predict one-year outcomes in pediatric anti-NMDA receptor encephalitis

• Type of Material: Article
• Authors: Jenny Lin, Emory University; Kathryn Elkins, Childrens Healthcare Atlanta; Sonam Bhalla, Emory University; Satyanarayana Gedela, Emory University; Ammar Kheder, Emory University; Guojun Zhang, Emory University; Leah Loerinc, Emory University; Laura Blackwell, Emory University; Robyn Howarth, Emory University; Grace Gombolay, Emory University
• Language: English
• Date: 2021-10-26
• Publisher: ELSEVIER
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2021 Elsevier B.V. All rights reserved.
• License: Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1016/j.eplepsyres.2021.106787
• Title of Journal or Parent Work: EPILEPSY RESEARCH
• Volume: 178
• Start Page: 106787
• End Page: 106787
• Grant/Funding Information: This work was funded by a Pediatric Research Alliance Pilot Grant from the Center for Clinical and Translational Research at Emory University and Children’s Healthcare of Atlanta.
• Keywords: Pediatric; Anti-NMDA receptor encephalitis; CHILDREN; Sleep; Science & Technology; Clinical Neurology; DIAGNOSIS; Neurosciences & Neurology; Life Sciences & Biomedicine; FEATURES; EEG; Electroencephalography; Delta brush

Abstract

Background: Electrographic characteristics (extreme delta brush, posterior dominant rhythm and slow waves) may predict outcomes in anti-NMDA receptor encephalitis (NMDARE). However, whether changes in EEG sleep architecture predict outcomes are unknown. We examine electrophysiological characteristics including sleep architecture in a pediatric NMDARE population and correlate with outcomes at one year. Methods: Retrospective chart and EEG review was performed in pediatric NMDARE patients at a single center. Patients with first EEGs available within 48 h of admission, prior to treatment, and one-year follow-up data were included. EEGs were independently reviewed by two epileptologists, and a third when disagreement occurred. Clinical outcomes included modified Rankin scale (mRS) at one year. Results: Nine patients (6 females) (range 1.9–16.7 years) were included. Five of nine patients had loss of posterior dominant rhythm (PDR) and three of nine patients had absent sleep architecture. Loss of PDR correlated with a worse mRS score at one year (2.8 versus 0.5, p = 0.038). Loss of PDR and loss of sleep architecture was associated with increased inpatient rehabilitation stay and in higher number of immunotherapy treatments administered. In multivariate analysis, absence of sleep architecture (p = 0.028), absence of PDR (p = 0.041), and epileptiform discharges (p = 0.041) were predictors of mRS at one year. Conclusions: Loss of normal PDR, absence of sleep architecture, and epileptiform discharges are associated with worse outcomes at one year which has not been reported before. EEG characteristics may help prognosticate in NMDARE. Larger studies are needed to confirm these findings.