Table 1.

Demographic and Clinical Characteristics

Patient	1	2	3	4	5	6
Age (years)	2	6	9	9	11	15
Ethnicity	Pacific Islander	Asian	White	White	Pacific Islander	Hispanic
Medical history	Previously healthy	Seizure disorder	ADHD	Previously healthy	Previously healthy	Previously healthy
Initial Presentation to medical care	Seizure	Withdrawn behavior, followed by status epilectus	Aggressive behavior	Found limp and crying at home	Headache, vertigo and abnormal movements	Seizures, psychosis
Clinical Findings	Persistent seizures, behavioral problems, altered gait, abnormal movements and neurological decline to unresponsiveness	Rapid progression to an unresponsive state with GCS of 3 which followed by recovery with catatonic state. Motoric return occurred rapidly with cognitive return lagging behind	Aggression, ataxia, confusion, loss of verbal and ambulation skills followed by. extensive autonomic instability with minimally conscious state associated with dystonic posturing and rigidity	Seizure activity noted in the emergency department, she also developed choreathetoid movements, behavioral outbursts, echolalia, and waxing and waning arousal	Disorientation, agitation, left facial and thumb twitching seizures, and deterioration to a coma with respiratory instability	Psychosis, somnolence, hallucinations, agitation, seizure and deterioration to a comatose state.
EEG	Right frontal delta slowing, no true epileptiform activity.	Diffuse slowing, right-sided attenuation, right hemispheric sharp waves.	Diffuse slowing and disorganization	Slowing over left hemisphere and asymmetric mu rhythm.	Right frontal, temporal, and parietal diffuse slowing.	Diffuse delta slowing.
Brain MRI	Initially normal, global atrophy at 2 weeks post admission to the University Hospital.	Bilateral areas of cortical, basal ganglia, and white matter T2; flair signal intensity.	Diffuse volume loss	Normal	Right parietal flare hyper- intensity. Repeat imaging showed resolution of signal intensity.	Normal
Identification of malignancy	Workup negative	Workup negative	Workup Negative	Workup negative	Pelvic ultrasound and CT identified right ovarian teratoma.	Pelvic CT and MRI revealed right ovarian teratoma.
Medical treatment	Anti-epileptics, methyl-prednisone, IVIG, plasmapheresis, rituximab.	Valproic acid, azythromycin, IVIG.	IVIG, plasmapheresis, cyclophosphamide, clonidine, levetiracetam, valproic acid, risperidone, propranolol	Anti-epileptics, IVIG, methyl-prednisone, plasmapheresis.	haloperidol, acyclovir, IVIG, methyl-prednisone. Surgical resection.	Anti-psychotics (quetiapine, olanzapine, and benztropine), anti-epileptics, methyl-prednisone, IVIG, plasmapheresis. Surgical resection.