PMC5904250_01
Disease course of the patient. Gray: real symptoms, adequate treatment; red: non-real neurological symptoms (dashed border), treatments in vain; purple: diagnostic findings. Abbreviations: abs, antibodies; AED, antiepileptic drugs; CASPR2, contactin-associated protein-2; CSF, cerebrospinal fluid; DDD, defined daily doses; EEG, electroencephalogram; EMG, electromyogram; IA, immunoadsorptions; MP, intravenous methylprednisolone; MRI, magnetic resonance imaging; Ps'ph, psychopharmacological agents; RTX, rituximab; y, years.
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F1
For a graphical presentation of the case, see Figure 1.
Electroencephalogram (EEG) recorded 12 days prior to the lumbar puncture and the autoantibody diagnostics. The depicted epochs were recorded 30-80 s after onset of hyperventilation (HV), a standard provocation maneuver of epileptiform activity in the EEG laboratory. The EEG was interpreted as follows: "irregular alpha-EEG with right fronto-centro-parieto focus and singular as well as grouped spike-wave complexes with abnormal rhythmizing; strong activation under HV with conduction to the contralateral side and short generalizations." In fact, this is a normal 9/s-alpha-EEG with physiological high-amplitude slowing under HV. It has been described before that is one typical reason for EEG misinterpretation leading to the erroneous diagnosis of epilepsy.
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F2
However, subsequent analysis of the suspicious EEG epochs by the author of this report revealed physiological activity without any potentials suggestive of epileptiform activity (Figure 2).