Autoimmune Thyroid Encephalopathy Presenting with Epilepsia Partialis Continua

We report the first case of an autoimmune thyroid encephalopathy presenting with multifocal motor status epilepticus. A 37-year-old female patient was admitted with multifocal motor seizures intractable to intravenous status epilepticus treatments, asymmetrical quadriparesis, truncal ataxia and continuous semi-rhythmical jerks. Pathological signal alterations were detected in both precentral cortices in MRI examination. Autoimmune thyroiditis was diagnosed after radiological examinations of the thyroid gland and thyroid function tests. Seizures promptly ceased following intravenous steroid treatment. Immunohistochemistry studies showed mild to moderate neuronal staining with the plasma and CSF samples. Remarkably, autoimmune thyroiditis may present with migrating focal motor status epilepticus. We recommend anti-thyroid antibody screening for multifocal motor status epilepticus cases of unspecified cause.

[1]  L. Rowland,et al.  What's in a NAIM? Hashimoto encephalopathy, steroid-responsive encephalopathy associated with autoimmune thyroiditis, or nonvasculitic autoimmune meningoencephalitis? , 2006, Archives of neurology.

[2]  T. Hashimoto,et al.  Anti-neuronal autoantibody in Hashimoto's encephalopathy: neuropathological, immunohistochemical, and biochemical analysis of two patients , 2004, Journal of the Neurological Sciences.

[3]  G. Moretto,et al.  Antithyroid antibodies in the CSF , 2003, Neurology.

[4]  B. Boeve,et al.  EEG findings in steroid-responsive encephalopathy associated with autoimmune thyroiditis , 2003, Clinical Neurophysiology.

[5]  À. Rovira,et al.  Reversible white matter alterations in encephalopathy associated with autoimmune thyroid disease , 2002, Journal of Neurology.

[6]  B. Abou-Khalil,et al.  Hashimoto’s encephalopathy: documentation of mesial temporal seizure origin by ictal EEG , 2001, Seizure.

[7]  J. Curnow,et al.  Restricted IgG1 subclass of anti-Yo antibodies in paraneoplastic cerebellar degeneration , 2001, Journal of Neuroimmunology.

[8]  J. Colebatch,et al.  Hashimoto's encephalopathy responding to plasmapheresis , 2001, Journal of neurology, neurosurgery, and psychiatry.

[9]  R. Simó,et al.  Encephalopathy associated to autoimmune thyroid disease: a more appropriate term for an underestimated condition? , 2000, Journal of the Neurological Sciences.

[10]  W. Paulus,et al.  Hashimoto encephalopathy: A brainstem vasculitis? , 2000, Neurology.

[11]  M. Hutchinson,et al.  Amnesic syndrome with bilateral mesial temporal lobe involvement in Hashimoto’s encephalopathy , 2000, Neurology.

[12]  C. Harper,et al.  Reversible MRI findings in a patient with Hashimoto's encephalopathy , 1997, Neurology.

[13]  C. Hess,et al.  Encephalopathy associated with Hashimoto thyroiditis: Diagnosis and treatment , 1996, Journal of Neurology.

[14]  R. Gilmore,et al.  Electroencephalographic findings in Hashimoto's encephalopathy , 1995, Neurology.

[15]  T. Walls,et al.  Hashirnoto's encephalopathy , 1991, Neurology.

[16]  N. Gadoth,et al.  Encephalopathy in compensated hashimoto thyroiditis: A clinical expression of autoimmune cerebral vasculitis , 1986, Brain and Development.

[17]  L. Brain,et al.  Hashimoto's disease and encephalopathy. , 1966, Lancet.

[18]  P. Shaw,et al.  Hashimoto's encephalopathy: a steroid-responsive disorder associated with high anti-thyroid antibody titers--report of 5 cases. , 1991, Neurology.