Ci a ion: Hobe , M.A.;
Da g ainiene, J.; Ma g a , N.G.
Gene alized Polyspike Pa e n in
EEG Due o Asep ic
Meningoencephali is. Diagnos ics
2023,13, 2569. h ps://doi.o g/
10.3390/diagnos ics13152569
Academic Edi o s: Ayman El-Baz
and F ank Webe
Recei ed: 2 July 2023
Re ised: 19 July 2023
Accep ed: 20 July 2023
Published: 2 Augus 2023
Copy igh : © 2023 by he au ho s.
Licensee MDPI, Basel, Swi ze land.
This a icle is an open access a icle
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A ibu ion (CC BY) license (h ps://
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diagnos ics
In e es ing Images
Gene alized Polyspike Pa e n in EEG Due o Asep ic
Meningoencephali is
Ma kus A. Hobe 1,* , Jus ina Da g ainiene 2and Nils G. Ma g a 1
1Depa men o Neu ology, Ch is ian-Alb ech Uni e si y o Kiel and Uni e si y Medical Cen e
Schleswig-Hols ein, 24105 Kiel, Ge many; n.ma g a @neu ologie.uni-kiel.de
2Ins i u e o Clinical Chemis y, Ch is ian-Alb ech Uni e si y o Kiel and Uni e si y Medical Cen e
Schleswig-Hols ein, 24105 Kiel, Ge many; [email p o ec ed]
*Co espondence: [email p o ec ed]
Abs ac :
We epo he elec oencephalog aphy (EEG) showing an in e mi en gene alized polyspike
pa e n in EEG due o an asep ic meningoencephali is in a 71-yea -old sopo ous pa ien . Ini ially,
she p esen ed wi h wo d- inding dis u bances and la e wi h gene alized onic–clonic seizu es. The
ce eb ospinal luid (CSF) showed pleocy osis o 99 leukocy es/
µ
L (p ima ily neu ophils) and an
inc eased p o ein le el o 1240 mg/L (CSF/se um glucose a io and lac a e un ema kable). Pa hogens
and au oimmune an ibodies in CSF we e no ound. B ain imaging was un ema kable. A e
an ibio ic, an i i al and an icon ulsi e he apy, he pa e n in he EEG was no longe de ec able. The
pa ien was discha ged o go home due o absence o any esidues.
Keywo ds: polyspike; asep ic meningoencephali is; elec oencephalog am
1
Figu e 1.
This elec oencephalog aphy (EEG) (10–20 sys em, sequen ial mon age, sensi i i y:
10
µ
V/mm, high equency il e s: 70 Hz, ime base: 15 mm/sec) showing an in e mi en gene alized
polyspike pa e n was ound in a 71-yea -old sopo ous pa ien due o an asep ic meningoencephali is.
Polyspikes (
A
) we e ollowed by del a wa es (
B
). Ini ially, he pa ien p esen ed wi h wo d- inding
dis u bances and la e wi h gene alized onic–clonic seizu es. The ce eb ospinal luid (CSF) showed
pleocy osis o 99 leukocy es/
µ
L (p ima ily neu ophils) and an inc eased p o ein le el o 1240 mg/L
(CSF/se um glucose a io and lac a e un ema kable, iden ical oligoclonal bands in se um and liquo ).
Pa hogens (Esche ichia coli, Haemophilus in luenzae, Lis e ia monocy ogenes, Neisse ia meningi-
idis, S ep ococcus agalac iae, S ep ococcus pneumoniae, Cy omegalo i us, En e o i us, He pes
simplex i us 1, He pes simplex i us 2, Va icella zos e i us, Cy omegalo i us, Human he pes i us 6,
Diagnos ics 2023,13, 2569. h ps://doi.o g/10.3390/diagnos ics13152569 h ps://www.mdpi.com/jou nal/diagnos ics
Diagnos ics 2023,13, 2569 2 o 3
Human pa echo i us, C yp ococcus neo o mans/ga ii, Tick Bo ne Encephali is i us and Bo elia
bu gdo e i) and au oimmune an ibodies (an ibodies agains amphiphysin, con ac in-associa ed
p o ein-2 [CASPR 2], collapsin esponse media o p o ein 5 [CRMP-5], gamma-aminobu y ic acid-b
[GABA b] ecep o , leucine- ich glioma inac i a ed 1 [LGI 1], Ma-p o eins, N-me hyl-D-aspa a e
[NMDA] ecep o , dipep idyl-pep idase-like p o ein 6 [DPPX], alpha-amino-3-hyd oxy-5-me hyl-
4-isoxazolep opionic acid [AMPA]- ecep o , Hu, Yo, Ri, glu amic acid deca boxylase [GAD] and
myelin oligodend ocy e glycop o ein [MOG]) we e no ound in CSF. Magne ic esonance imaging
(MRI) o he b ain wi h con as agen was un ema kable. The apy was conduc ed wi h le e i ace am
(2
×
1 g/die), lacosamide (2
×
100 mg/die), ce iaxone, ampicillin and acyclo i . A e clinical
imp o emen , he pa e n in he EEG was no longe de ec able. The CSF a e 8 days was no malized
(cell coun 3 leukocy es/
µ
L). The pa ien was discha ged o go home due o absence o any esidues.
Ten mon hs la e , he pa ien was examined in he ou pa ien clinic. She epo ed ha no seizu es
occu ed. The EEG was no mal wi h no epilep i o m discha ges. A polyspike pa e n in EEG ep e-
sen s in e ic al epilep i o m discha ges. I has been ound in di e en immunological and s uc u al
condi ions. Among hese a e encephali is wi h MOG-an ibodies [
1
] and wi h an i-ganglioside an i-
bodies [
2
] o Hashimo o encephalopa hy [
3
]. In gene al, EEG changes we e ound in pa ien s wi h
in lamma o y p ocesses in he b ain [
4
]. Slow wa es, epilep i o m discha ges and elec oencephalic
seizu es we e common in he pes encephali is [
5
]. In au oimmune encephali is, gene alized o ocal
slowing, epilep i o m discha ges and elec oencephalog aphic seizu es we e ound [
6
]. Up o 28%
o pa ien s wi h asep ic meningi is wi hou seizu es had gene alized and ocal slowing [
7
]. In he
epo ed case, no pa hogens o au oimmune an ibodies we e ound. B ain MRI also showed no
s uc u al changes. Howe e , conside ing he symp oms wi h epo ed and obse ed gene alized
onic-clonic seizu es [
8
], he clinical cou se wi h imp o emen a e ea men ini ia ion, and he
absence o he polyspike pa e n on EEG a e ea men ini ia ion, i is mos likely ha he polyspike
pa e n was associa ed wi h meningoencephali is. Al hough he cause o he meningoencephali is
(i.e., asep ic) was no ound in he case epo ed he e, neu ologis s should be awa e ha a polyspike
pa e n in EEG may be associa ed wi h an in lamma o y p ocess in he b ain. The e o e, app op ia e
diagnos ics should be pe o med i a polyspike pa e n is ound in he EEG.
Au ho Con ibu ions:
Concep ualiza ion, M.A.H. and N.G.M.; in es iga ion, M.A.H., J.D. and
N.G.M.; w i ing—o iginal d a p epa a ion, M.A.H.; w i ing— e iew and edi ing, J.D. and N.G.M.;
isualiza ion, M.A.H. All au ho s ha e ead and ag eed o he published e sion o he manusc ip .
Funding: This esea ch ecei ed no ex e nal unding.
Ins i u ional Re iew Boa d S a emen : No applicable.
In o med Consen S a emen :
The pa ien p o ided w i en in o med con en o publica ion o his
EEG eco ding and clinical in o ma ion.
Da a A ailabili y S a emen : No applicable.
Con lic s o In e es : The au ho s decla e no con lic o in e es .
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Fishe , R.S.; C oss, J.H.; F ench, J.A.; Higu ashi, N.; Hi sch, E.; Jansen, F.E.; Lagae, L.; Moshé, S.L.; Pel ola, J.; Roule Pe ez, E.; e al.
Ope a ional classi ica ion o seizu e ypes by he In e na ional League Agains Epilepsy: Posi ion Pape o he ILAE Commission
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