Hashimoto's Encephalitis: Rare Cause of Seizures and Status Epilepticus
Abstract number :
2.140
Submission category :
Year :
2000
Submission ID :
1228
Source :
www.aesnet.org
Presentation date :
12/2/2000 12:00:00 AM
Published date :
Dec 1, 2000, 06:00 AM
Authors :
Gautam Ganguly, Steven Schreiber, David Y Ko, Univ of Southern CA, Los Angeles, CA.
Rationale: Hashimoto's encehalopathy is a rare disorder in patients with Hashimoto's thyroidits, an autoimmune disease inwhich they have antithyroid antibodies. Hashimoto's encehalopathy presents with a wide variety of neurologic symptoms including seizures in patients who may be euthyroid or hypothyroid. Method: Three recent patients of ages 13, 60 and 76 who presented with abnormal behavior, confusion, psychosis and intermittent seizures were diagnosed and treated for Hashimoto's encehalopathy. Results: Two of the three patients had generalized tonic-clonic seizures and infact one presented with status epilepticus and the third patient had myoclonus. Their EEGs ranged from periodic lateralized epileptiform discharges (PLEDS) to frequent epileptiform activity consistent with severe cortical irritability. All of them had a working diagnosis of chronic meningoencephalitis of unknown cause till it was found that their antithyroid antibodies were abnormally elevated which suggested Hashimoto's encehalopathy. Their sedimentation rates were elevated as well. The thyroid function tests as well as their thyroid ultrasounds were normal. Neuroimaging was unremarakable in all. Cerebral angiogram was done on one of them looking for vasculitis but the study was normal. All these patients when started on high doses of methyl prednisone responded dramatically, their mental status improved and their seizures stopped. EEG repeated after the treatment was normal in all the patients. Discussion: Hashimoto's encephalopathy should be considered in the differential diagnosis of atypical presentations of seizures including myoclonic seizures, generalized tonic clonic seizures and even status epilepticus. Hashimoto's encehalopathy is diagnosed with antithyroid antibodies in patients with neurlogoic symptoms who may otherwise be euthyroid or hyopthyroid. Hashimoto's encehalopathy and the seizures associated with it is a steroid responsive entity and early diagnosis and treatment will prevent long term complications and morbidity.