A 66-year-old woman with type 2 diabetes and hypertension in regular control was admitted for 3 weeks of onset with behavioral alteration, irritability, insomnia, visual disturbances and temporal-spatial confusion.
A secondary generalized focal seizure syndrome was associated with this, reaching an epiphyseal status.
The patient required admittance to the institution treatment unit 3 g levetiracetam IV, sedation with midazolam IV and mechanical ventilation for seizure control, which was only partial.
The electroencephalogram (EEG) showed epileptic activity: “very frequent lateralized periodic discharges, predominantly left anterior and intermittent presence of overlying bipheral defect, around 0.5-1.5 Hz and occasional rapid and irregular activity”.
The CSF showed no increase in the count of cells with 0 whites, MRI in the FLAIR sequence showed extensive involvement of frontal white matter and bilateral temporal.
The viral study was negative for herpes and other viruses in CSF. The immunological study highlighted the elevation of anti-PDMO antibody levels with normal seizure frequency < 100. The patient was treated with a TSH level of 2.27 uU/mL.
A study of anti-NMDA antibodies was also requested, and similar were those that were highly positive for antibodies against the GABA-A receptor in the cerebrospinal fluid.
The test was performed in the laboratory of Dr. Joseph Dalmau with in vivo techniques in determined cells to express subunits of the GABA-A3 receptor. Posterior Capetioprine therapy was initiated 4 weeks with clear achievement of day
The study of occult neoplasia with scanner of thorax, abdomen and pelvis was negative.
