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目的了解自身免疫性脑炎患者的脑电图(EEG)和诱发电位改变,以提高临床早期诊断和治疗。方法收集2014年6月18日—2016年6月18日在四川省人民医院神经内科8例自身免性脑炎患者临床资料,所有患者的血液和脑脊液标本均送北京协和医院神经内科实验室做相关抗体的测定;患者至少做2次以上常规EEG和(或)视频脑电图(VEEG),1次以上脑干诱发电位(Auditory brainstem response,ABR)、上肢体感诱发电位(Somatosensory evoked potential,上肢SEP)、下肢体感诱发电位(下肢SEP)、视觉诱发电位(Visual evoked potential,VEP)的检查。患者出院后对其临床症状、EEG进行随访,对诱发电位有异常的患者进行关注。结果患者的临床表现精神行为异常、癫痫发作、记忆力减退、发热头痛、严重者意识障碍和通气功能下降;8例患者中5例为抗NMDA-R脑炎,2例为抗GABAB-R脑炎,1例是两者均为阳性。抗NMDA-R脑炎的EEG:2例患者病程早期(10 d)出现β波,中期(20 d)出现δ波,在此波上叠加快波,呈现δ刷,2例患者病情重,住院时间长,头颅核磁共振(MRI)阴性,治疗以激素冲击,丙种球蛋白,其中1例使用血浆置换疗法,临床预后良好;另2例可见散在的尖波和尖慢波,病情好转,EEG也有好转;1例EEG为正常,使用激素冲击治疗,临床预后好。抗GABAB-R脑炎:1例以慢波为主,治疗以激素冲击和丙种球蛋白,治疗后EEG恢复正常,临床预后好;另1例表现α波泛化,尤其在额区也出现α波,患者放弃治疗。抗NMDA-R和GABABR均为阳性患者,EEG表现慢波,病情好转,EEG好转。体感诱发电位检测中大部分未见异常,部分患者出现异常:波幅的改变,潜伏期轻度延长,异常患者出院3个月后随访,结果均为正常。结论不同类型自身免疫性脑炎的EEG表现不尽一致,不同的病程阶段有相应的改变,EEG可作为疾病预后的指标。早期EEG有快波出现且临床疑诊脑炎时,应及时筛查血与脑脊液的NMDA-R抗体;EEG出现α波泛化,需注意GABAB-R抗体的筛查。部分患者诱发电位改变在波幅和潜伏期轻度延长,出院3个月复查大部分恢复正常。由于病例数较少,诱发电位在自身免疫性脑炎患者中的改变需进一步研究。
Objective To understand the changes of electroencephalogram (EEG) and evoked potentials in patients with autoimmune encephalitis to improve the early clinical diagnosis and treatment. Methods The clinical data of 8 patients with autoimmune encephalitis in the department of neurology of Sichuan Provincial People’s Hospital from June 18, 2014 to June 18, 2016 were collected. Blood and cerebrospinal fluid samples of all patients were sent to the Peking Union Medical College Hospital for Neurology Related antibodies. At least 2 or more routine EEG and / or video EEG (VEEG), more than one auditory brainstem response (ABR), somatosensory evoked potential (upper extremity SEP), lower extremity somatosensory evoked potential (lower extremity SEP), visual evoked potential (VEP) examination. Patients discharged after the clinical symptoms, EEG follow-up, evoked potentials in patients with abnormal attention. Results The clinical manifestations of patients were psychiatric disorders, epileptic seizures, memory loss, fever headache, severe disturbance of consciousness and decreased ventilatory function. Among the 8 patients, 5 were anti-NMDA-R encephalitis and 2 were anti-GABAB-R encephalitis , One was positive for both. EEG of anti-NMDA-R encephalitis: β wave appeared in the early stage of disease (10 days) in the course of disease and δ wave in the middle stage (20 days). Fast wave was superimposed on the wave with δ brush, and two patients were seriously ill and hospitalized A long time, head MRI, negative hormone therapy, treatment of hormones, gamma globulin, including 1 case of plasma exchange therapy, the clinical prognosis was good; the other 2 cases were scattered spikes and sharp waves, the condition improved, EEG also Improved; one case of normal EEG, the use of hormone therapy, the clinical prognosis is good. Anti-GABAB-R encephalitis: one case was mainly slow wave, and treated with hormonal impact and gamma globulin. The EEG returned to normal after treatment, and the clinical prognosis was good. The other case showed alpha wave generalization, especially in frontal area Wave, patients give up treatment. Anti-NMDA-R and GABABR are positive patients, EEG performance of slow wave, the condition improved, EEG improved. Most of the somatosensory evoked potentials showed no abnormalities, and some patients showed abnormalities: the amplitude was changed and the incubation period was slightly prolonged. All patients were followed up for 3 months after discharge. The results were normal. Conclusion The EEG of different types of autoimmune encephalitis are not consistent, and different stages of the disease have corresponding changes. EEG can be used as an index of disease prognosis. Early EEG with fast wave appears and clinical suspected encephalitis, the blood and cerebrospinal fluid NMDA-R antibody should be timely screening; EEG α-wave generalization, pay attention to GABAB-R antibody screening. Some patients evoked potential changes in the amplitude and latency slightly extended, most of the 3 months after discharge returned to normal. Due to the small number of cases, evoked potential changes in patients with autoimmune encephalitis need further study.