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December 2, 2022
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Cathodal Transcranial Direct Current Stimulation for Treatment of Rasmussen Encephalitis

March 7, 2023 issue
100 (10) 484-485
A 9-year-old woman presented with acute amnesia and dysphasia, resolving within 24 hours. After 2 months of episodic altered behavior, she developed right leg focal motor seizures with secondary generalization. FLAIR MRI, CT, and brain biopsy confirmed the diagnosis of Rasmussen encephalitis (Figure), a progressive inflammatory neurologic disease. 1
Figure Rasmussen Encephalitis
(A) FLAIR MRI with left temporal lobe and superior frontal gyrus changes in Rasmussen encephalitis. (B) CT showed hemicortical atrophy. (C) Focal epileptiform EEG changes localized to C3/P3. (D) Location of anode (FP2) and cathode (C3/P3) for cathodal transcranial DC stimulation (2 mA; 20 minutes daily for 8 days).
Despite anticonvulsants and prednisolone-azathioprine immunotherapy, the seizures evolved over 12 months to epilepsia partialis continua (Video 1), with hemiparesis, cognitive decline, and focal EEG changes. To avoid hemispherectomy, cathodal transcranial DC stimulation was administered once daily 2 (Figure, D). After 8 days, seizures stopped for 18 weeks, and she could ambulate unaided (Video 1).
Video 1

Acknowledgment

We would like to thank the patient and her family who generously shared video material for the purpose of this case study.

References

1.
Varadkar S, Bien CG, Kruse CA. Rasmussen's encephalitis: clinical features, pathobiology, and treatment advances. Lancet Neurol. 2014;13(2):195–205.
2.
Tekturk P, Erdogan ET, Kurt A, et al. Transcranial direct current stimulation improves seizure control in patients with Rasmussen encephalitis. Epileptic Disord. 2016;18(1):58–66.

Information & Authors

Information

Published In

Neurology®
Volume 100Number 10March 7, 2023
Pages: 484-485
PubMed: 36460475

Publication History

Received: June 7, 2022
Accepted: October 18, 2022
Published online: December 2, 2022
Published in print: March 7, 2023

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Disclosure

The authors report no disclosures relevant to the manuscript. Go to Neurology.org/N for full disclosures.

Study Funding

The authors report no targeted funding.

Authors

Affiliations & Disclosures

From the Translational and Clinical Research Institute (K.A.B., K.P., M.R.B.), Newcastle University, The Medical School, Framlington Place; Department of Northern Medical Physics & Clinical Engineering (K.A.B.), Newcastle Hospitals NHS Foundation Trust; Department of Paediatric Neurology (K.P.), The Great North Children's Hospital, Royal Victoria Infirmary, Newcastle Upon Tyne; and Department of Clinical Neurophysiology (M.R.B.), Royal Victoria Infirmary, Newcastle Upon Tyne, United Kingdom.
Disclosure
Scientific Advisory Boards:
1.
None
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
None
Editorial Boards:
1.
NONE
Patents:
1.
NONE
Publishing Royalties:
1.
NONE
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
NONE
Speakers' Bureaus:
1.
NONE
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
NONE
Research Support, Government Entities:
1.
NONE
Research Support, Academic Entities:
1.
NONE
Research Support, Foundations and Societies:
1.
None
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
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1.
NONE
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1.
NONE
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Ki Pang, PhD, FRCPCH
From the Translational and Clinical Research Institute (K.A.B., K.P., M.R.B.), Newcastle University, The Medical School, Framlington Place; Department of Northern Medical Physics & Clinical Engineering (K.A.B.), Newcastle Hospitals NHS Foundation Trust; Department of Paediatric Neurology (K.P.), The Great North Children's Hospital, Royal Victoria Infirmary, Newcastle Upon Tyne; and Department of Clinical Neurophysiology (M.R.B.), Royal Victoria Infirmary, Newcastle Upon Tyne, United Kingdom.
Disclosure
Scientific Advisory Boards:
1.
None
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
None
Editorial Boards:
1.
NONE
Patents:
1.
NONE
Publishing Royalties:
1.
NONE
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
NONE
Speakers' Bureaus:
1.
NONE
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
NONE
Research Support, Government Entities:
1.
NONE
Research Support, Academic Entities:
1.
NONE
Research Support, Foundations and Societies:
1.
None
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
Stock/stock Options, Research Sponsor:
1.
NONE
Stock/stock Options, Medical Equipment & Materials:
1.
NONE
Legal Proceedings:
1.
NONE
Mark R. Baker, PhD, FRCP
From the Translational and Clinical Research Institute (K.A.B., K.P., M.R.B.), Newcastle University, The Medical School, Framlington Place; Department of Northern Medical Physics & Clinical Engineering (K.A.B.), Newcastle Hospitals NHS Foundation Trust; Department of Paediatric Neurology (K.P.), The Great North Children's Hospital, Royal Victoria Infirmary, Newcastle Upon Tyne; and Department of Clinical Neurophysiology (M.R.B.), Royal Victoria Infirmary, Newcastle Upon Tyne, United Kingdom.
Disclosure
Scientific Advisory Boards:
1.
None
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
None
Editorial Boards:
1.
NONE
Patents:
1.
NONE
Publishing Royalties:
1.
NONE
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
NONE
Speakers' Bureaus:
1.
NONE
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
NONE
Research Support, Government Entities:
1.
(1) National Institute for Health Research (NIHR), COV-LT2-0022, Principal Investigator, 2021-2023(2) UKRI-Medical Research Council, EP/V050419/1, Co-Investigator, 2021-2022
Research Support, Academic Entities:
1.
NONE
Research Support, Foundations and Societies:
1.
(1) The Lily Foundation (Lily-Stonegate Research Award), Co-Investigator, 2020-2024(2) Parkinson's Disease UK, Co-Investigator, 2020-2024(3) Dunhill Medical Trust, Co-Investigator, 2020-2024]
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
Stock/stock Options, Research Sponsor:
1.
NONE
Stock/stock Options, Medical Equipment & Materials:
1.
NONE
Legal Proceedings:
1.
NONE

Notes

Correspondence Mrs. Bangel [email protected]
Go to Neurology.org/N for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.
Submitted and externally peer reviewed. The handling editor was José Merino, MD, MPhil, FAAN.

Author Contributions

K. A. Bangel: Drafting/revision of the manuscript for content, including medical writing for content. K. Pang: Drafting/revision of the manuscript for content, including medical writing for content; Analysis or interpretation of data. M.R. Baker: Drafting/revision of the manuscript for content, including medical writing for content; Analysis or interpretation of data.

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