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A 23-year-old Caucasian woman presented acutely to the emergency department with mild confusion and recurring stereotyped seizures that comprised a tingling sensation in her right arm and leg, followed by a generalised tonic–clonic seizure. She had been diagnosed with anti-N-methyl D-aspartate (NMDA)-receptor encephalitis 4 years previously, having presented with psychosis and generalised convulsive status epilepticus that required intubation. She had made an excellent recovery with no further symptoms and had been maintained on methotrexate until 3 months previously when it was stopped as she was stable.
MR imaging of the brain was normal. Investigations for malignancy, including whole-body positron emission tomography/CT and transvaginal ultrasound, were normal. She was treated as a relapse with intravenous corticosteroids and plasma exchange. Repeat testing of her NMDA …
Contributors AA: summarised the patient’s presentation and investigation results. Proposed initial draft manuscript and performed initial literature search. AG: significant contributions to discussion section on electrophysiological features of extreme delta brushes and brief ictal rhythmic discharges (BIRDS). RJ: significant contributions to discussion section on electrophysiological features of extreme delta brushes and BIRDS. GM: revised the work critically and redrafted aspects. SJ: revised the work critically and redrafted aspects. All authors agree to be accountable for all aspects of the published case report.
Competing interests None declared.
Patient consent Obtained.
Provenance and peer review Not commissioned; externally peer reviewed. This paper was reviewed by Nick Kane, Bristol, UK.