Differentiation of the first psychotic episode and autoimmune encephalitis with anti-NMDA receptor antibodies, using the EEG findings – case report and literature review

IF 0.7 Q4 PSYCHIATRY

Postepy Psychiatrii i Neurologii Pub Date : 2020-01-01 DOI:10.5114/ppn.2020.94696

A. Hirschfeld, Daniel Lubiński, Łukasz Szumerowicz

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引用次数: 0

Abstract

Purpose: The first-time psychotic incident is a diagnostic challenge due to the lack of definite tests that initially verify the underlying cause. Differential diagnosis should include autoimmune encephalitis with anti-NMDA receptors antibodies (NMDARE). The waiting time for the antibodies determination, being the only method of confirmation, may exceed several days. The article presents the capability of electroencephalographic study (EEG) to strengthen the NMDARE suspicion. Case description: In a 19-year-old healthy woman sudden behavioural changes occurred. Initially, psychotic episode was diagnosed. Severity of the symptoms and no reaction to the treatment determined further diagnostics. Based on clinical symptoms and EEG, NMDARE was diagnosed and adequate treatment initiated. Antibody assay confirmed this diagnosis. Comment: The presence of extreme delta brush in the EEG with the clinical suspicion of NMDARE allows to accelerate therapy in anticipation of antibodies determination. The EEG can be a valuable diagnostic tool for differential diagnosis, especially in the first psychotic episode.

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首次精神病发作与抗nmda受体抗体自身免疫性脑炎的脑电图鉴别——病例报告及文献回顾

目的:第一次精神病事件是一个诊断挑战，由于缺乏明确的测试，初步验证的根本原因。鉴别诊断应包括具有抗nmda受体抗体(NMDARE)的自身免疫性脑炎。抗体测定作为唯一的确认方法，等待时间可能超过几天。本文介绍了脑电图研究(EEG)加强NMDARE怀疑的能力。病例描述:一名19岁健康女性突然发生行为改变。最初，诊断为精神病发作。症状的严重程度和对治疗的无反应决定了进一步的诊断。根据临床症状和脑电图诊断NMDARE并开始适当治疗。抗体检测证实了这一诊断。评论:临床怀疑NMDARE的脑电图中出现的极端delta刷可以加速抗体测定的治疗。脑电图是鉴别诊断的一种有价值的诊断工具，特别是在首次精神病发作时。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Postepy Psychiatrii i Neurologii Psychology-Clinical Psychology

CiteScore

0.90

自引率

0.00%

发文量

期刊介绍： The quarterly Advances in Psychiatry and Neurology is aimed at psychiatrists, neurologists as well as scientists working in related areas of basic and clinical research, psychology, social sciences and humanities. The journal publishes original papers, review articles, case reports, and - at the initiative of the Editorial Board – reflections or experiences on currently vivid theoretical and practical questions or controversies. Articles submitted to the journal are evaluated first by the Section Editors, specialists in the fields of psychiatry, clinical psychology, science of the brain and mind and neurology, and reviewed by acknowledged authorities in the respective field. Authors and reviewers remain anonymous to each other.