摘要：

目的 总结神经元表面抗体相关脑炎临床表现、脑电图和头部MRI特点，探讨脑电图对判断疾病复发或波动的意义，以及与MRI 病灶相对应的脑电图特点和各临床病程分期的脑电图特点。方法 共23 例神经元表面抗体相关脑炎患者，根据临床病程分期分为上升期、极期、下降期和恢复期，记录脑电图背景活动、慢波分布范围、样放电和极度δ刷，分析其与疾病复发或波动的关系、与头部MRI表现的一致性，以及各病程分期的脑电图特点。结果 23 例患者中19 例为抗N-甲基-D-天冬氨酸（NMDA）受体脑炎、3 例为抗富亮氨酸胶质瘤失活基因1 抗体相关脑炎、1 例为抗γ-氨基丁酸B 型受体脑炎。临床症状发生率由高至低依次为精神症状或认知功能障碍、癫发作、意识障碍、言语障碍和运动障碍。发病30.50 d 内6 例脑电图背景活动为慢波，其中2 例疾病复发或波动；5 例背景活动为α节律，无一例复发或波动。有极度δ刷与无极度δ刷的抗NMDA 受体脑炎患者首次住院时间（Z = -0.785，P = 0.433）和疾病复发或波动发生率（Fisher 确切概率法：P = 0.155）差异均无统计学意义。各病程分期脑电图背景活动与头部MRI 表现并不完全匹配。上升期和极期脑电图背景活动多为慢波，且慢波分布范围相对较广泛；自下降期开始，背景活动以α节律为主；恢复期慢波分布范围缩小。结论 疾病早期脑电图背景活动可能与疾病复发或波动有关。各病程分期脑电图改变与头部MRI表现的不匹配提示应重视神经元表面抗体相关脑炎患者的神经功能检查。不同病程分期脑电图特点不同。

关键词: 自身免疫疾病, 脑炎, 受体, N-甲基-D-天冬氨酸, 受体, GABA, 脑电描记术, 磁共振成像

Abstract:

Objective  To summarize the clinical manifestations, EEG and head MRI features of neuronal surface antibody associated encephalitis, and to investigate the role of EEG in determining the relapse or fluctuation of this disease, characteristics of EEG corresponding to head MRI, and EEG features in different clinical stages. Methods  A total of 23 patients with neuronal surface antibody associated encephalitis were divided into ascent, climax, descent and recovery stage according to their clinical course. The relation between EEG background activity, distribution of slow wave, epileptiform discharge, extreme delta brush (EDB) and relapse or fluctuation of the disease was analyzed. The relation between EEG features and head MRI abnormalities, and also EEG features in different stages were analyzed. Results  There were 19 anti-N-methyl-D-aspartate (NMDA) receptor encephalitis patients, 3 anti-leucine-rich glioma-inactivated 1 (LGI1) antibody associated encephalitis and one anti-γ-aminobutyric acid B receptor (GABABR) antibody associated encephalitis. The frequencies of clinical presentations were psychological or cognitive dysfunction, epileptic seizure, conscious disturbance, speech dysfunction and movement disorder in descending order. Within 30.50 d from onset, 6 patients demonstrated slow wave background, of whom 2 relapsed or fluctuated; 5 patients had α rhythm background and none of them relapsed or fluctuated. In patients with anti-NMDA receptor encephalitis, the difference in first hospital stay (Z = -0.785, P = 0.433) and relapse or fluctuation (Fisher's exact probability: P = 0.155) between EDB group and non-EDB group was not significant. There was no apparent correlation between EEG background activities and head MRI abnormalities in different stages. In ascent and climax stage, EEG background activities were predominantly slow wave, and the distribution of slow wave was relatively broader. EEG background changed to α rhythm from descent stage and slow wave distribution decreased in recovery stage.  Conclusions  Some presentations of EEG, such as early background activities may be correlated with disease relapse or fluctuation. The incompatibility of EEG and head MRI suggests the importance of functional examinations in patients with neuronal surface antibody associated encephalitis. EEG features vary in different stages.

Key words: Autoimmune diseases, Encephalitis, Receptors, N-methyl-D-aspartate, Receptors, GABA, Electroencephalography, Magnetic resonance imaging