Abstract Details

Title EEG Features That Associate with One-Year Outcomes in Pediatric Anti-NMDA Receptor Encephalitis

Topic Autoimmune Neurology

Presentation(s) P9 - Poster Session 9 (11:45 AM-12:45 PM)

Poster/Presentation
Number 8-007

Objective

To assess whether electroencephalography (EEG) features associate with one-year outcomes in anti-NMDA receptor encephalitis (NMDARE).

Background

Electroencephalography (EEG) is abnormal in ~90% of patients with anti-NMDA receptor encephalitis.^1-3 However, limited data is available on EEG characteristics associated with poor outcomes in pediatric NMDARE (pNMDARE).

Design/Methods

We performed a multi-site retrospective cohort study (CONNECT study) from 14 institutions in the United States, including children under 18 years of age diagnosed with pNMDARE.^4,5 The modified Rankin Score (mRS) was used to define good (mRS ≤ 2) and poor (mRS ≥ 3) outcomes at one year from onset. Initial EEG features obtained from EEG reports were included. Univariate and multivariate logistic regressions were performed with R CRAN (v4.4.1).

Results

In this cohort (n=249), 226 (91%) children had initial EEG data and one-year mRS available. An abnormal EEG was noted in 200/246 (81%), with findings that included: background slowing (154/246=63%), epileptiform discharges (81/246=33%), and extreme delta brush (13/217=6%). Seizures were recorded in 39/246 (16%) and status epilepticus in 18/246 (7%). The only EEG feature associated with one-year outcomes on univariate analysis was background slowing (p=0.043). On multivariate analysis, background slowing on EEG had an odds ratio of 5.5 (95% 2.4–12.9) were associated with poor one-year outcomes when adjusting for ICU admission and non-improvement within four weeks of immunotherapy initiation. The proportion of abnormal EEG in routine versus prolonged EEGs was not significant (p=0.056), but seizures and status epilepticus were more likely to be detected on prolonged EEGs (p=0.0003 and p=0.0009, respectively) as compared to routine EEGs, which could either reflect that these features are detected on a longer EEG versus a longer EEG was ordered due to the seizures and/or status epilepticus.

Conclusions

Alterations in the EEG background was associated with poor one-year outcomes, even after adjusting for ICU admission and improvement within four weeks.

Authors/Disclosures
Grace Gombolay, MD, FAAN (Emory University/Children'S Healthcare of Atlanta) PRESENTER	The institution of Dr. Gombolay has received research support from CDC. The institution of Dr. Gombolay has received research support from NIH.
James N. Brenton, MD, FAAN	Dr. Brenton has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for I-ACT on a Novartis sponsored project. The institution of Dr. Brenton has received research support from NIH/NINDS. The institution of Dr. Brenton has received research support from Autoimmune Encephalitis Alliance. Dr. Brenton has received publishing royalties from a publication relating to health care. Dr. Brenton has received personal compensation in the range of $500-$4,999 for serving as a Grant Reviewer with Department of Defense. Dr. Brenton has received personal compensation in the range of $0-$499 for serving as a Grant Reviewer with NIH. Dr. Brenton has received personal compensation in the range of $0-$499 for serving as a Grant Reviewer with FDA.
Jennifer H. Yang, MD (Rady Childrens Hospital/UCSD)	Dr. Yang has received research support from Pediatric Epilepsy Research Foundation. Dr. Yang has received research support from NIH.
Coral M. Stredny, MD (Children's Hospital Boston)	Dr. Stredny has stock in Proctor and Gamble. The institution of Dr. Stredny has received research support from Pediatric Epilepsy Research Foundation.
Ryan Kammeyer, MD (Childrens Hospital Colorado)	The institution of Dr. Kammeyer has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Amgen. The institution of Dr. Kammeyer has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Novartis. Dr. Kammeyer has received personal compensation in the range of $500-$4,999 for serving as an Expert Witness for Ogborn-Mihm Trial Lawyers. The institution of Dr. Kammeyer has received research support from Rocky Mountain Multiple Sclerosis Center.
Kristen Fisher, DO (Baylor College of Medicine)	Dr. Fisher has nothing to disclose.
Alexander Sandweiss, MD, PhD	Dr. Sandweiss has nothing to disclose.
Timothy Erickson (Texas A&M University)	Timothy Erickson has received research support from Centers for Disease Control and Prevention.
Varun Kannan, MD (Emory/CHOA)	Dr. Kannan has nothing to disclose.
Catherine E. Otten, MD	The institution of Dr. Otten has received research support from CDC.
NgocHanh H. Vu, MD (Vanderbilt University, Child Neurology)	Dr. Vu has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Syneos Health.
Jonathan Santoro, MD (Department of Neurology, Children's Hospital Los Angeles)	Dr. Santoro has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for UCB. Dr. Santoro has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Cycle Pharma. Dr. Santoro has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Dianthus. Dr. Santoro has received personal compensation in the range of $500-$4,999 for serving as a Consultant for National Down Syndrome Society.
Karla Robles Lopez (UNIVERSITY OF TEXAS AT AUSTIN/DMS)	Karla Robles Lopez has nothing to disclose.
Robert C. Goodrich III, MD	Dr. Goodrich has nothing to disclose.
Scott I. Otallah, MD (Wake Forest)	Dr. Otallah has received personal compensation in the range of $500-$4,999 for serving as an Expert Witness for Merck.
Janetta L. Arellano, MD (CHOC)	Dr. Arellano has nothing to disclose.
Andrew Christiana, MD (NYU)	Dr. Christiana has nothing to disclose.
Morgan Morris (Emory University)	Morgan Morris has nothing to disclose.
Mark Gorman, MD	The institution of Dr. Gorman has received research support from Pfizer. The institution of Dr. Gorman has received research support from Roche / Genetech .
Alexandra B. Kornbluh, MD (Children's National Hospital)	Dr. Kornbluh has nothing to disclose.
Ilana L. Kahn, MD (Childrens National Medical Center)	Dr. Kahn has nothing to disclose.
Leigh N. Sepeta, PhD (Children'S National Health System)	Dr. Sepeta has received personal compensation in the range of $500,000-$999,999 for serving as a Grant PI with Nih. Dr. Sepeta has a non-compensated relationship as a Special volunteer with Nih that is relevant to AAN interests or activities.
Yike Jiang	Yike Jiang has nothing to disclose.
Eyal Muscal	Eyal Muscal has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for sobi. An immediate family member of Eyal Muscal has stock in pfizer.
Kristy Murray (Baylor College of Medicine)	No disclosure on file
Manikum Moodley, MD, FAAN	Dr. Moodley has nothing to disclose.
Duriel I. Hardy, MD (Dell Children's Specialty Pavillian)	Dr. Hardy has nothing to disclose.
Claude Steriade, MD (NYU)	The institution of Dr. Steriade has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for The Epilepsy Study Consortium. Dr. Steriade has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Dynamed. Dr. Steriade has received personal compensation in the range of $5,000-$9,999 for serving as an Expert Witness for DOJ. The institution of Dr. Steriade has received research support from NIH. Dr. Steriade has received personal compensation in the range of $500-$4,999 for serving as a Consultant with Epitel. Dr. Steriade has received personal compensation in the range of $500-$4,999 for serving as a Consultant with Jazz Pharmaceuticals. Dr. Steriade has received personal compensation in the range of $10,000-$49,999 for serving as a Speakers Bureau with SK Life Sciences. Dr. Steriade has received personal compensation in the range of $5,000-$9,999 for serving as a Speakers Bureau with Neurelis. Dr. Steriade has received personal compensation in the range of $5,000-$9,999 for serving as a Advisory Board with Xenon Pharmaceuticals.

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