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

Adam Hirschfeld; Daniel Lubiński; Łukasz Szumerowicz

doi:10.5114/ppn.2020.94696

eISSN: 2720-5371
ISSN: 1230-2813

Advances in Psychiatry and Neurology/Postępy Psychiatrii i Neurologii

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abstract:

Case report

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

Adam S. Hirschfeld

¹

,

Daniel Lubiński

¹

,

Łukasz Szumerowicz

¹

Neurology Ward, The St. John Paul II HCP Medical Centre, Poznan, Poland

Adv Psychiatry Neurol 2020; 29 (1): 67-73

DOI: https://doi.org/10.5114/ppn.2020.94696

Online publish date: 2020/04/27

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AMA

Hirschfeld AS, Lubiński D, Szumerowicz Ł. Differentiation of the first psychotic episode and autoimmune encephalitis with anti-NMDA receptor antibodies, using the EEG findings – case report and literature review. Advances in Psychiatry and Neurology/Postępy Psychiatrii i Neurologii. 2020;29(1):67-73. doi:10.5114/ppn.2020.94696.

APA

Hirschfeld, A. S., Lubiński, D.,  & Szumerowicz, Ł. (2020). Differentiation of the first psychotic episode and autoimmune encephalitis with anti-NMDA receptor antibodies, using the EEG findings – case report and literature review. Advances in Psychiatry and Neurology/Postępy Psychiatrii i Neurologii, 29(1), 67-73. https://doi.org/10.5114/ppn.2020.94696

Chicago

Hirschfeld, Adam S, Daniel Lubiński,  and Łukasz Szumerowicz. 2020. "Differentiation of the first psychotic episode and autoimmune encephalitis with anti-NMDA receptor antibodies, using the EEG findings – case report and literature review". Advances in Psychiatry and Neurology/Postępy Psychiatrii i Neurologii 29 (1): 67-73. doi:10.5114/ppn.2020.94696.

Harvard

Hirschfeld, A., Lubiński, D.,  and Szumerowicz, Ł. (2020). Differentiation of the first psychotic episode and autoimmune encephalitis with anti-NMDA receptor antibodies, using the EEG findings – case report and literature review. Advances in Psychiatry and Neurology/Postępy Psychiatrii i Neurologii, 29(1), pp.67-73. https://doi.org/10.5114/ppn.2020.94696

MLA

Hirschfeld, Adam et al. "Differentiation of the first psychotic episode and autoimmune encephalitis with anti-NMDA receptor antibodies, using the EEG findings – case report and literature review." Advances in Psychiatry and Neurology/Postępy Psychiatrii i Neurologii, vol. 29, no. 1, 2020, pp. 67-73. doi:10.5114/ppn.2020.94696.

Vancouver

Hirschfeld A, Lubiński D, Szumerowicz Ł. Differentiation of the first psychotic episode and autoimmune encephalitis with anti-NMDA receptor antibodies, using the EEG findings – case report and literature review. Advances in Psychiatry and Neurology/Postępy Psychiatrii i Neurologii. 2020;29(1):67-73. doi:10.5114/ppn.2020.94696.

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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.

keywords:

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

Adam S. Hirschfeld 1 , Daniel Lubiński 1 , Łukasz Szumerowicz 1

autoimmune encephalitis, NMDA, psychosis, EEG, extreme delta brush

Adam S. Hirschfeld

¹

,

Daniel Lubiński

¹

,

Łukasz Szumerowicz

¹