Predictive values and specificity of electroencephalographic findings in autoimmune encephalitis diagnosis

Early diagnosis of autoimmune encephalitis (AE) to not delay treatment is challenging but needed in practice. Most previous evidences of electroencephalographic (EEG) findings in AE were derived from descriptive studies. Given paucity of evidence of specific EEG findings to help with early diagnosis...

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Bibliographic Details
Published in:	Epilepsy & behavior Vol. 84; pp. 29 - 36
Main Authors:	Limotai, Chusak, Denlertchaikul, Chayaporn, Saraya, Abhinbhen W., Jirasakuldej, Suda
Format:	Journal Article
Language:	English
Published:	United States Elsevier Inc 01-07-2018
Subjects:	Autoimmune encephalitis EEG Predictive values Specificity Specificity EEG Predictive values Autoimmune encephalitis
Online Access:	Get full text
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Summary:	Early diagnosis of autoimmune encephalitis (AE) to not delay treatment is challenging but needed in practice. Most previous evidences of electroencephalographic (EEG) findings in AE were derived from descriptive studies. Given paucity of evidence of specific EEG findings to help with early diagnosis of AE, this study aimed to ascertain specific EEG findings and assess their predictive values in diagnosis of AE. We included all cases with AE in our institution from January 2013 to June 2017. Cases were matched with controls by age and level of consciousness (1:2 ratio). Potential confounders for EEG findings collected as baseline characteristics were compared. Two epileptologists independently reviewed EEGs. Standardized terminology, definitions, and scoring system of EEG findings were employed. Logistic regression analysis was performed, and diagnostic performance of significant EEG features was assessed. Twenty cases and 40 controls were included in this study. Poorly sustained posterior dominant rhythm (PDR) was significantly associated with AE (p = 0.007) and even more predictive in anti-N-methyl-d-aspartate (NMDA) encephalitis. Inter-rater agreement (kappa) was 0.714. None of the cases had normal EEG nor Grand Total EEG (GTE) score < 4 (negative predictive value (NPV) of 100%). Specificity of well sustained PDR to exclude the diagnosis of anti-NMDA encephalitis was high (91.67%). Simple EEG assessment can be used to help exclude AE. When AE is suspected, careful assessment of the sustainment of the PDR is warranted. The NPV of GTE score < 4 and specificity of well sustained PDR can be simply used to differentiate many conditions from AE. •Early diagnosis of autoimmune encephalitis (AE) to not delay treatment is warranted in practice.•Specific EEG findings and their predictive values in early diagnosis of AE have been rarely studied.•This comparative study suggests simple EEG assessment which can be used to help exclude AE.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	1525-5050 1525-5069
DOI:	10.1016/j.yebeh.2018.04.007