Electroencephalographic findings in Bickerstaff’s brainstem encephalitis: A possible reflection of the dysfunction of the ascending reticular activating system
Objectives: Bickerstaff’s brainstem encephalitis (BBE) is a rare post-infectious inflammatory disease, which causes impaired consciousness by the dysfunction of the ascending reticular activating system (ARAS). We aimed to clarify EEG changes possibly caused by the dysfunction of the ARAS in BBE. Me...
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doaj-c37cd2535b7742f28fb264080d41e8ef2021-01-10T04:11:01ZengElsevierClinical Neurophysiology Practice2467-981X2021-01-0162935Electroencephalographic findings in Bickerstaff’s brainstem encephalitis: A possible reflection of the dysfunction of the ascending reticular activating systemHajime Yoshimura0Masaya Togo1Junko Ishii2Hiroyuki Ishiyama3Ryota Tamura4Masamune Kimura5Takehito Kuroda6Susumu Kusunoki7Michi Kawamoto8Nobuo Kohara9Department of Neurology, Kobe City Medical Center General Hospital, Japan; Corresponding author at: Department of Neurology, Kobe City Medical Center General Hospital, 2-1-1 Minatojima-minamimachi, Chuo-ku, Kobe 650-0047, Japan.Department of Neurology, Kobe City Medical Center General Hospital, Japan; Division of Neurology, Kobe University Graduate School of Medicine, JapanDepartment of Neurology, Kobe City Medical Center General Hospital, JapanDepartment of Neurology, Kobe City Medical Center General Hospital, JapanDepartment of Neurology, Kobe City Medical Center General Hospital, Japan; Department of Neurology, Shiga University of Medical Science, JapanDepartment of Neurology, Kobe City Medical Center General Hospital, JapanDepartment of Neurology, Kobe City Medical Center General Hospital, JapanDepartment of Neurology, Kindai University, Faculty of Medicine, JapanDepartment of Neurology, Kobe City Medical Center General Hospital, JapanDepartment of Neurology, Kobe City Medical Center General Hospital, JapanObjectives: Bickerstaff’s brainstem encephalitis (BBE) is a rare post-infectious inflammatory disease, which causes impaired consciousness by the dysfunction of the ascending reticular activating system (ARAS). We aimed to clarify EEG changes possibly caused by the dysfunction of the ARAS in BBE. Methods: We retrospectively investigated 15 EEGs from 5 patients with definite BBE (i.e., the positivity for serum IgG anti-GQ1b antibodies was mandatory for the diagnosis) admitted to our hospital from January 2014 through December 2019, particularly focusing on whether N1 and N2 sleep patterns were maintained. Results: All of the 10 EEGs recorded when patients had consciousness disturbance were abnormal. Stereotypical EEG changes correlating with their level of consciousness were identified: poorly organized posterior dominant rhythms with maintenance of sleep patterns in patients with mild consciousness disturbance (n = 5); predominant N1 and/or N2 sleep patterns even with external stimuli, including spindle coma pattern, in patients with moderate consciousness disturbance (“unarousable sleep-like” EEG) (n = 4); and generalized slow waves without N1 and N2 sleep patterns in patients with severe consciousness disturbance (n = 1). Among 5 patients, 3 (60%) had “unarousable sleep-like” EEG in their clinical course. Conclusions: Patients with BBE showed stereotypical EEG changes correlating with their level of consciousness, mostly with maintenance of N1 and N2 sleep patterns, and often exhibited characteristic “unarousable sleep-like” EEG. Significance: This study revealed characteristic EEG changes possibly caused by the dysfunction of the ARAS, which can be a diagnostic clue for BBE.http://www.sciencedirect.com/science/article/pii/S2467981X20300366Altered mental statusBickerstaff’s brainstem encephalitisElectroencephalographyReticular formationSleep patternSpindle coma |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Hajime Yoshimura Masaya Togo Junko Ishii Hiroyuki Ishiyama Ryota Tamura Masamune Kimura Takehito Kuroda Susumu Kusunoki Michi Kawamoto Nobuo Kohara |
spellingShingle |
Hajime Yoshimura Masaya Togo Junko Ishii Hiroyuki Ishiyama Ryota Tamura Masamune Kimura Takehito Kuroda Susumu Kusunoki Michi Kawamoto Nobuo Kohara Electroencephalographic findings in Bickerstaff’s brainstem encephalitis: A possible reflection of the dysfunction of the ascending reticular activating system Clinical Neurophysiology Practice Altered mental status Bickerstaff’s brainstem encephalitis Electroencephalography Reticular formation Sleep pattern Spindle coma |
author_facet |
Hajime Yoshimura Masaya Togo Junko Ishii Hiroyuki Ishiyama Ryota Tamura Masamune Kimura Takehito Kuroda Susumu Kusunoki Michi Kawamoto Nobuo Kohara |
author_sort |
Hajime Yoshimura |
title |
Electroencephalographic findings in Bickerstaff’s brainstem encephalitis: A possible reflection of the dysfunction of the ascending reticular activating system |
title_short |
Electroencephalographic findings in Bickerstaff’s brainstem encephalitis: A possible reflection of the dysfunction of the ascending reticular activating system |
title_full |
Electroencephalographic findings in Bickerstaff’s brainstem encephalitis: A possible reflection of the dysfunction of the ascending reticular activating system |
title_fullStr |
Electroencephalographic findings in Bickerstaff’s brainstem encephalitis: A possible reflection of the dysfunction of the ascending reticular activating system |
title_full_unstemmed |
Electroencephalographic findings in Bickerstaff’s brainstem encephalitis: A possible reflection of the dysfunction of the ascending reticular activating system |
title_sort |
electroencephalographic findings in bickerstaff’s brainstem encephalitis: a possible reflection of the dysfunction of the ascending reticular activating system |
publisher |
Elsevier |
series |
Clinical Neurophysiology Practice |
issn |
2467-981X |
publishDate |
2021-01-01 |
description |
Objectives: Bickerstaff’s brainstem encephalitis (BBE) is a rare post-infectious inflammatory disease, which causes impaired consciousness by the dysfunction of the ascending reticular activating system (ARAS). We aimed to clarify EEG changes possibly caused by the dysfunction of the ARAS in BBE. Methods: We retrospectively investigated 15 EEGs from 5 patients with definite BBE (i.e., the positivity for serum IgG anti-GQ1b antibodies was mandatory for the diagnosis) admitted to our hospital from January 2014 through December 2019, particularly focusing on whether N1 and N2 sleep patterns were maintained. Results: All of the 10 EEGs recorded when patients had consciousness disturbance were abnormal. Stereotypical EEG changes correlating with their level of consciousness were identified: poorly organized posterior dominant rhythms with maintenance of sleep patterns in patients with mild consciousness disturbance (n = 5); predominant N1 and/or N2 sleep patterns even with external stimuli, including spindle coma pattern, in patients with moderate consciousness disturbance (“unarousable sleep-like” EEG) (n = 4); and generalized slow waves without N1 and N2 sleep patterns in patients with severe consciousness disturbance (n = 1). Among 5 patients, 3 (60%) had “unarousable sleep-like” EEG in their clinical course. Conclusions: Patients with BBE showed stereotypical EEG changes correlating with their level of consciousness, mostly with maintenance of N1 and N2 sleep patterns, and often exhibited characteristic “unarousable sleep-like” EEG. Significance: This study revealed characteristic EEG changes possibly caused by the dysfunction of the ARAS, which can be a diagnostic clue for BBE. |
topic |
Altered mental status Bickerstaff’s brainstem encephalitis Electroencephalography Reticular formation Sleep pattern Spindle coma |
url |
http://www.sciencedirect.com/science/article/pii/S2467981X20300366 |
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