AOCCN 2025: Acquired Epileptic Aphasia in NMDA Encephalitis: A Unique Electroclinical Presentation with Pathophysiological Considerations

Presenter: Dr. Madhu Gaddigoudar

This study describes a case of school-aged boy with symptoms suggestive of Landau-Kleffner Syndrome (LKS, a rare childhood epileptic encephalopathy).

The patient with normal premorbid development showed progressive language regression and seizures. Initial EEG revealed a continuous spike-wave pattern during non-REM sleep (suggestive of LKS). Nevertheless, subsequent EEG demonstrated an extreme delta brush pattern, and MRI showed multifocal diffusion restriction. CSF was positive for anti-NMDA receptor antibodies, confirming NMDARE. The patient underwent immunotherapy with intravenous methylprednisolone followed by plasma exchange. This was coupled with optimised anti-seizure therapy and speech rehabilitation. The child showed remarkable clinical improvement and was seizure free with complete recovery of language and function (modified Rankin Scale score 0) at 12-month follow-up.

This unique case highlights the clinical and electrophysiological overlap between LKS and NMDARE. Early identification and appropriate immunotherapy have a crucial role in neurological recovery, especially when the patient has atypical presentations of autoimmune encephalitis mimicking epileptic aphasia.

AOCCN 2025, September 17th-20th 2025, New Delhi, India.