Epilepsy Associated With Anti-NMDAR Encephalitis:Case Analysis And Investigation Of Antiepileptic Drug Use

Objective1.To investigate the clinical features of epilepsy associated with anti-NMDAR encephalitis2. To assess the effectiveness of antiepileptic drugs in the control of epilepsy associated with anti-NMDAR encephalitis.Methods Object of study : This study included in hospitalised patients in Children’ s Hospital of Chongqing Medical University from January 2013 to November 2015.Clinical data: including gender, age, clinical manifestation, seizure,auxiliary examination and treatment of antiepileptic drugs.Follow up: The useage of Antiepilepsy drug, concentration of antiepileptic drug and side effects, seizures, EEG, brain MRI and other contents in children with epilepsy associated with anti-NMDAR encephalitis were followed up by telephone or nerve specialist clinic.Statistical methods: use SPSS 20 to analysis data. Measurement data,if accord with normal distribution, then ues the average ± standard deviation,and T test to test,if not, use Wilcoxon rank sum test. Count data,using the chi-square test, P < 0.05 for statistically significant.Result We totally collected 39 patients with anti-NMDAR encephalitis,which 11 cases(28.21%) patients without seizures, 28 cases(71.79%) had seizures, mean age 7-8 years, more women than men(female: male = 2:1).Only a part of the patients with precuosor symptoms, mainly for fever,headache. Lack of specificity in routine and biochemical examination of cerebrospinal fluid. The positive rate of NMDAR antibody in cerebrospinal fluid was 100%, and the positive rate of NMDAR antibody was lower than that of cerebrospinal fluid. Video EEG examination to increaseing of slow wave and epileptic discharge based. Magnetic resonance imaging(MRI)about 42.8% can be found in patients with abnormal signal, and the main performance of T1 and slightly long abnormal T2 signal or long T1 signal,suggesting that it is possible to demyelinating lesions or cerebral softening,parts mainly involving the thalamus, globus pallidus, insular, midbrain,frontal lobe and parietal lobe. The results of tumor markers in our hospital were negative. 28 cases had chest and abdominal CT scan and enhancement or chest CT scan and ultrasonography of the abdomen or chest X-ray to excluded from space occupying lesions in the thoracic and abdominal.There were 22 cases had seizures, 16 cases of them were treated with antiepileptic drugs, 6 cases did not add antiepileptic drugs. 2 cases in the 11 patients without epileptic seizures add epileptic drugs due to EEG epilepsy discharge.Conclusion This study summarizes the characteristics of clinical manifestations,imaging examination and cerebrospinal fluid of NMDAR antibodies examination in the epilepsy associated with anti-NMDAR encephalitis, and summarizes the useage of antiepileptic drugs, the experience should be provided for the clinical practice and further prospective study to pave the way.