Anti-leucine-rich Glioma-inactivated 1 Encephalitis Manifesting as Frequent Ictal Pouting and Subtle Memory Disturbance.

in Internal medicine (Tokyo, Japan) by Takeshi Araki, Hajime Yoshimura, Kenta Tsuchida, Noriko Hatanaka, Michi Kawamoto

TLDR

  • This study is about a man who had a rare type of brain infection called anti-LGI1 encephalitis. He had frequent seizures and memory problems, but he didn't have any other symptoms. The study found that he had a rare seizure feature called ictal pouting, which was resolved with steroid treatment. The study also found that steroid treatment improved his memory. This study highlights the importance of evaluating patients with memory problems for brain infections like anti-LGI1 encephalitis and suggests that steroid treatment may be an effective treatment option for this condition.

Abstract

Anti-leucine-rich glioma-inactivated 1 (LGI1) encephalitis is a treatable form of limbic encephalitis, marked by frequent focal seizures and cognitive decline (particularly memory disturbance); however, it can be difficult to diagnose in patients with subtle cognitive decline. Ictal pouting, a rare seizure feature, has not yet been reported in anti-LGI1 encephalitis. A 73-year-old man with anti-LGI1 encephalitis presented with subacute onset of frequent ictal pouting without apparent cognitive decline. Steroid treatment alone resolved seizures and improved subtle visual memory. Middle-aged and older patients experiencing subacute-onset frequent focal seizures should be thoroughly evaluated for memory disturbances to determine the need for anti-LGI1 antibody measurement.

Overview

  • The study focuses on the diagnosis and treatment of anti-LGI1 encephalitis, a treatable form of limbic encephalitis characterized by frequent focal seizures and cognitive decline. The hypothesis being tested is whether ictal pouting, a rare seizure feature, can be observed in anti-LGI1 encephalitis. The methodology used for the experiment includes a case study of a 73-year-old man with anti-LGI1 encephalitis who presented with subacute onset of frequent ictal pouting without apparent cognitive decline. The study aims to determine if ictal pouting is a common feature of anti-LGI1 encephalitis and if steroid treatment can resolve seizures and improve subtle visual memory in patients with this condition.

Comparative Analysis & Findings

  • The study found that ictal pouting is a rare seizure feature in anti-LGI1 encephalitis. The patient's seizures were resolved with steroid treatment alone, and subtle visual memory improved. The findings suggest that steroid treatment may be an effective treatment option for anti-LGI1 encephalitis in patients with ictal pouting.

Implications and Future Directions

  • The study highlights the importance of thoroughly evaluating patients with subacute-onset frequent focal seizures for memory disturbances to determine the need for anti-LGI1 antibody measurement. The findings also suggest that steroid treatment may be an effective treatment option for anti-LGI1 encephalitis in patients with ictal pouting. Future research should focus on identifying other rare seizure features in anti-LGI1 encephalitis and exploring the use of other treatment options, such as immunomodulatory drugs.
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