PMC4150645_01
Timeline of Case 1. Clock drawing as a sample of the cognitive assessment before plasma exchange (A), after plasma exchange (notice the relative worsening, attributed to the side effects of the treatment) (B), and two (C) and five (D) months following plasma exchange, with increasingly better performance. The clock was fully accurate only on the last test. (E) This representative right temporal encephalographic seizure was recorded during a night's sleep. LMT : lamotrigine, CBZ : carbamazepine, VPA : valproate, LEV : levetiracetam, GBP : gabapentin, CLB : clobazam, PRD : prednisone, PE : plasma exchange, MoCA : Montreal Cognitive Assessment.
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Although no clinical improvement was noted at first, EEG monitoring demonstrated significant improvement after 14 days, with only one EEG-verified electroencephalographic seizure per night, compared to 3-4 electroencephalographic seizures per night before the plasma exchange (Fig. 1E). Cognitive assessment (Montreal Cognitive Assessment [MoCA]) performed before and after plasma exchange revealed a mild cognitive impairment (24/30, mainly attention deficit and memory) that improved by two points after receiving treatment (Figs. 1A-D).
PMC4150645_02
Timeline of Case 2. Clock drawing as a sample of the cognitive assessment before methylprednisolone treatment (A), immediately after the steroid pulse therapy (B), and one month (C) and 7 months (D) following treatment, that begun 5 month after the first admission. These drawings demonstrate progressive improvement. T2 FLAIR axial section at the time of diagnosis (E) and 2 months later (F), showing a progressive periventricular hyperintense signal with increasing atrophy. LMT : lamotrigine, VPA : valproate, LEV : levetiracetam, TPM : topiramate, GBP : gabapentin, MET : methylprednisolone, PRD : prednisone, MoCA : Montreal Cognitive Assessment.
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Further measurement of the antithyroid antibodies demonstrated a marked reduction (anti-TPO: 349 U/ml, antithyroglobulin: 461 U/ml, Fig. 2).