Clinical and Electrographic Features and Outcomes of Status Epilepticus versus Non-status Epilepticus Patients with Anti-NMDA Receptor Encephalitis
Abstract number :
2.183
Submission category :
4. Clinical Epilepsy / 4D. Prognosis
Year :
2023
Submission ID :
1212
Source :
www.aesnet.org
Presentation date :
12/3/2023 12:00:00 AM
Published date :
Authors :
Presenting Author: Ashar Farooqi, M.B.B.S – Mayo Clinic, Rochester, Minnesota
Ahmad Sawalha, M.B.B.S. – Mayo Clinic, Rochester, Minnesota; Divyanshu Dubey, M.B.B.S. – Mayo Clinic, Rochester, Minnesota; Jeffrey Britton, M.D. – Mayo Clinic, Rochester, Minnesota; Kelsey Smith, M.D. – Mayo Clinic, Rochester, Minnesota
Rationale: Anti-NMDA receptor encephalitis (NMDARE) is one of the most common causes of autoimmune encephalitis that predominantly affects young females. Neuropsychiatric disturbances and seizures are hallmarks of the disease, which conventionally evolve to encephalopathy, dyskinesia, and autonomic symptoms. We sought to determine clinical and electrographic features associated with status epilepticus (SE) and describe long-term outcomes.
Methods: In this retrospective study, we included adult and pediatric patients with seizures in the setting of NMDARE treated at inpatient Mayo Clinic sites during the acute phase of encephalitis between October 2008 and March 2023. Initial presentation (seizure semiology and other associated symptoms), electrographic features, neuroimaging findings, treatment course, complications, and last clinic follow-up visit were abstracted. Clinical features were compared between patients with and without SE epilepticus.
Results: We identified twenty-nine patients with NMDARE, including eight (27%) pediatric patients. Twelve (41%) patients had SE during admission for acute encephalitis. Two had focal motor SE, eight had focal non-convulsive SE with coma, and two had bilateral tonic clonic. The status epilepticus patients were more likely to have recorded temporal onset seizures (p=0.025), intensive care unit (ICU) admission (p=0.003), and more antiseizure medications (p=0.0001). One patient (3.4%) from the total cohort died during the acute encephalitis and one patient (3.4%) developed chronic epilepsy after resolved encephalitis in the setting of left temporoparietal encephalomalacia that developed during the acute encephalitis.
Conclusions: Status epilepticus develops in many patients with NMDARE and is associated with temporal onset seizures, ICU admission, and the need for more antiseizure medications. Despite many patients having status epilepticus, most patients with NMDARE become seizure free after treatment of the acute encephalitis.
Funding: None
Clinical Epilepsy