Anti-LGI1 Limbic Encephalitis Presented with Atypical Manifestations

Abstract

Anti-leucine-rich glioma inactivated-1 (LGI1) limbic encephalitis (LE) is a rare neurological disorder that has a subacute course of progressive encephalopathy and fasciobrachial dystonic seizures. We report a patient with anti-LGI1 LE that presented with atypical manifestations that complicated the diagnosis. A 62-year-old woman presented with a chronic course of memory disturbance and a subsequent relapse with an altered mental status after 10 months. The patient reported frequent chest pain of squeezing and dull nature, typically lasting 10-30 seconds. The chest pain was related to partial seizures, which were confirmed by video-EEG monitoring. Anti-LGI1 antibody was identified in serum and CSF. The patient's symptoms improved by immune modulation treatment. Patients with anti-LGI1 LE can experience atypical partial seizures, and a chronic relapsing course. Clinical suspicions and video-EEG monitoring are helpful for the early diagnosis and effective immune modulation.

Keywords: chest pain; immune; limbic encephalitis; seizure.

Fig. 1

EEG revealed rhythmic sharp and slow waves (a) and rhythmic theta build-ups (b) in the right temporal area. The patient felt chest discomfort simultaneously with theseictal discharges.

Fig. 2

The patient's serum was reacted with an LGI1 antigen expressing cell line. Cell membranous immunofluorescence was detected on a cellbased indirect immunofluorescence test.