Abstracts

Rationale: Patients with Steroid Responsive Encephalopathy Associated with Thyroiditis (SREAT), also known as Hashimoto s Encephalopathy, may present with seizures. There are no well-established treatment guidelines. Our case series describes patients with this presentation who then develop subclinical seizures. In cases of ongoing encephalopathy it is essential recognize subclinical seizures and to assure they are adequately treated. Methods: We retrospectively reviewed the clinical presentation, imaging, laboratory analysis and electroencephalography in a series of two patients with SREAT. The setting is the University of Colorado Comprehensive Epilepsy Center, a tertiary referral center in the Rocky Mountain region. Patients were admitted after initial presentation with status epilepticus. We then performed a meta- analysis on all case reports of SREAT published since 1982 to determine presence of seizures and response to treatment. Results: Including our two patients, there are a total of 34 patients with SREAT in this analysis. Forty-four percent of these presented in status epilepticus. As per definition all responded to high dose steroids. In addition to steroids, 8 others received other immunomodulatory agents including azathioprine (3), cyclosporine (1), methotrexate (2), IVIG (1). 38% regressed with discontinuation of immunomodulation. Conclusions: The focus of most of these series did not include an analysis of repeat EEG to determine if ongoing encephalopathy or psychosis was the result of increased seizure activity, as was their presenting symptoms. Numerous of these relapsed patients were encephalopathic and in our series both had either definitive seizures and/or hyperirritable cortex on EEG. These results emphasize the need to repeat EEG in cases of relapse of encephalopathy or psychosis and suggest that immunomodulation in combination with antiepileptic drug therapy is needed for good resolution of seizures.