PMC6069820_01
a, b Brain magnetic resonance imaging (MRI) on admission did not show intracranial abnormality on fluid attenuated inverse recovery (FLAIR) (a) or gadolinium enhancement (b). c, d Interictal electroencephalography on admission demonstrated bilateral intermittent delta activity predominantly in bilateral frontal region (c), and periodic epileptiform discharges predominantly in the bilateral frontal area were seen every 0.5-1.0 s on day 15, suggesting continuing seizure activity
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Fig1
Magnetic resonance imaging (MRI) showed no intracranial lesion or abnormal gadolinium enhancement (Fig. 1a, b). Interictal electroencephalogram showed generalized periodic delta waves predominantly on the bilateral frontal areas (Fig. 1c). During days 15-19, EEG showed periodic sharp discharges predominantly on the bilateral frontal regions every 0.5-1.0 s even during the patient did not manifest apparent seizure (Fig. 1d), suggesting the condition of non-convulsive status epilepticus (NCSE).
After administration of plasma exchange, the patient gradually regained consciousness and eventually discontinued long-term mechanical ventilation and general anesthesia. IVMP, intravenous methylprednisolone; PE, plasma exchange; IVIG, intravenous immunoglobulin; VPA, sodium valproate; LEV, levetiracetam; CBZ, carbamazepine; ZNS, zonisamide; LTG, lamotrigine
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Fig2
We administered plasma exchange (PE) on days 31-35 and intravenous immunoglobulin therapy (IVIG) on days 36-38 (0.4 g/kg for 3 days), under the informed consent of his family (Fig. 2).