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Chronic periodic lateralised epileptic discharges and anti‐N‐methyl‐D‐aspartate receptor antibodies
Author(s) -
Sakakibara Eisuke,
Takahashi Yukitoshi,
Murata Yoshiko,
Taniguchi Go,
Sone Daichi,
Watanabe Masako
Publication year - 2014
Publication title -
epileptic disorders
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.673
H-Index - 53
eISSN - 1950-6945
pISSN - 1294-9361
DOI - 10.1684/epd.2014.0655
Subject(s) - ictal , pathophysiology , magnetoencephalography , status epilepticus , nmda receptor , neuroscience , cerebrospinal fluid , psychology , positron emission tomography , medicine , electroencephalography , pathology , epilepsy , receptor
Periodic lateralised epileptiform discharges (PLEDs) are uncommon transient electroencephalographic findings accompanied by acute brain lesions. A small proportion of PLEDs persist for more than three months and are called “chronic” PLEDs, the pathophysiology of which is still debated. Herein, we report a man with right hemispheric PLEDs which lasted for more than 14 months and mild left hemispatial neglect after he experienced status epilepticus. Although MRI was normal, positron emission tomography revealed right temporo‐parieto‐occipital hypometabolism, which coincided with the source area of PLEDs estimated by magnetoencephalography. In addition, levels of anti‐ N ‐methyl‐ d ‐aspartate (NMDA) receptor antibodies and granzyme B were found to be high in the cerebrospinal fluid. Following two courses of steroid pulse therapy, the patient's left spatial neglect improved and the PLEDs were partially resolved. These findings suggest that the chronic PLEDs present in this case were an interictal phenomenon and that their pathophysiology involved autoimmune processes.