The effect of dexmedetomidine on status epilepticus in a patient with anti-NMDA receptor encephalitis
- PDF / 711,446 Bytes
- 3 Pages / 595.276 x 790.866 pts Page_size
- 91 Downloads / 194 Views
CORRESPONDENCE
The effect of dexmedetomidine on status epilepticus in a patient with anti-NMDA receptor encephalitis Flaminia Coluzzi, MD . Albina Angelini, MD . Maurizio Simmaco, MD, PhD . Daniela Alampi, MD . Elisa Alessandri, MD . Eugenio Grassi, RNT . Maria Grazia Monina, MD . Monica Rocco, MD
Received: 8 May 2020 / Revised: 17 June 2020 / Accepted: 17 June 2020 Ó Canadian Anesthesiologists’ Society 2020
To the Editor, A 35-yr-old Caucasian woman was hospitalized in psychiatry, 8 months after childbirth (G2P2), for psychomotor agitation, visual hallucinations, and incoherent speech. On admission, electroencephalography (EEG), brain imaging (computed tomography and magnetic resonance imaging), and cerebrospinal fluid (CSF) examination showed no abnormalities. On day 7, she was found unconscious, and she was intubated and
F. Coluzzi, MD (&) Department of Medical and Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy e-mail: [email protected] Unit of Anesthesia and Intensive Care Medicine, Sant’Andrea University Hospital, Rome, Italy A. Angelini, MDE. Alessandri, MDM. G. Monina, MD Unit of Anesthesia and Intensive Care Medicine, Sant’Andrea University Hospital, Rome, Italy M. Simmaco, MD, PhD Department of Neurosciences, Mental Health and Sensory Organs, Sapienza University of Rome, Rome, Italy Advanced Molecular Diagnostic Unit, Sant’Andrea University Hospital, Rome, Italy D. Alampi, MDM. Rocco, MD Unit of Anesthesia and Intensive Care Medicine, Sant’Andrea University Hospital, Rome, Italy Department of Clinical and Surgical Translational Medicine, Sapienza University of Rome, Rome, Italy E. Grassi, RNT Unit of Neurophysiopathology, University Hospital Sant’Andrea, Rome, Italy
admitted to the intensive care unit (ICU). After successful liberation from mechanical ventilation, she developed status epilepticus (SE) alternating with periods of agitation. SE persisted despite combined treatment with phenytoin sodium, levetiracetam, and delorazepam. Intravenous dexmedetomidine (0.4 lgkg-1hr-1) was administrated for conscious sedation, according to local protocols, and improvement from the SE was observed in 30 min, as documented with EEG tracings. Electroencephalography spectral analysis showed a significant increase in beta activity, which is typical of dexmedetomidine (Figure). SE relapsed after dexmedetomidine interruption and resolved when the infusion was restarted. Oral lacosamide was prescribed as second-line therapy for drug-resistant SE, but the patient’s clinical condition worsened and dysautonomic signs became more evident, including hypertension, tachycardia, and a very high body temperature ([ 39°C). Lumbar puncture was repeated to investigate an autoimmune etiology and anti-N-methyl-D-aspartate receptor (NMDA-R) antibodies were detected in the CSF. Immunoglobulins, high-dose corticosteroids, and subsequent plasmapheresis were administered with success. N-methyl-D-aspartate receptor antibodies are a rare cause of autoimmune encephalitis, often misdiagnosed w
Data Loading...
