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E-Pearl of the Week: LGI1 Antibodies in Limbic Encephalitis

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Brought to you by the Residents & Fellows Section of Neurology®.

May 29, 2013

Limbic encephalitis is attributed to antibody-mediated processes in an increasing number of cases. Since 2010, antibodies to accessory proteins of the voltage-gated potassium channel complex have been described, namely leucine-rich glioma-inactivated (LGI1) and contactin-associated protein 2 (CASPR2). LGI1 antibody associated limbic encephalitis is characterized by clinical seizures in 82% of patients, and video-EEG monitoring suggests tonic seizures may be the most common seizure-type. Additionally, hyponatremia occurs in 60% of patients, thought secondary to LGI1 expression in the hypothalamus and kidney. With immunotherapy, more than three quarters will achieve significant recovery.

References

  1. Lai M, Huijbers MG, Lancaster E, et al. Investigation of LGI1 as the antigen in limbic encephalitis previously attributed to potassium channels: a case series. Lancet Neurology 2010; 9: 776-785.
  2. Andrade DM, Tai P, Dalmau J, Wennberg R. Tonic seizures: A diagnostic clue of anti-LGI1 encephalitis?  Neurology 2011;76:1355-1357.

Submitted by Adam Numis MD, Resident Physician, University of California, San Francisc

Disclosure: Dr. Numis serves on the editorial team for the Neurology Resident and Fellow Section.

For more clinical pearls and other articles of interest to neurology trainees, visit the Neurology Residents & Fellows page. Listen to this week's Neurology Podcast.

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