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. 2018 Apr 2;5(5):646-650.
doi: 10.1002/acn3.561. eCollection 2018 May.

Elevated LGI1-IgG CSF index predicts worse neurological outcome

Avi Gadoth  1   2 , Anastasia Zekeridou  1   2 , Christopher J Klein  1   2 , Colton J Thoreson  2 , Masoud Majed  2 , Divyanshu Dubey  1   2 , Eoin P Flanagan  1   2 , Andrew McKeon  1   2 , Sarah M Jenkins  3 , Vanda A Lennon  1   2   4 , Sean J Pittock  1   2
Affiliations

Elevated LGI1-IgG CSF index predicts worse neurological outcome

Avi Gadoth et al. Ann Clin Transl Neurol. .

Abstract

To determine whether CSF leucine-rich glioma-inactivated 1(LGI1)-IgG titer, index or IgG subclass has prognostic significance, we tested serum and CSF specimens collected concomitantly from 39 seropositive patients. LGI1-IgG index was elevated (>1) in 21 patients (54%), suggesting intrathecal synthesis. Patients with worse outcome at last follow-up (modified Rankin Scale >2) had significantly higher index (median 6.57 vs. 0.5, P = 0.048) compared to those with better outcome. Higher CSF LGI1-IgG4 subclass-specific titer and index correlated with worse outcome (P < 0.005 for both). These data suggest that evidence of intrathecal LGI1-IgG synthesis may correlate with neuronal injury and warrant consideration of aggressive immunotherapy.

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Figures

Figure 1
Figure 1
(A) Patients with unfavorable outcome (mRS>2) had higher LGI1‐IgG index by comparison with patients with a favorable outcome (P = 0.048). (B) Individual patients’ LGI1‐IgG index per mRS score at last follow‐up.
Figure 2
Figure 2
(A) Patients with unfavorable outcome (mRS>2) had higher LGI1‐IgG4 subclass‐specific CSF index by comparison with patients with a favorable outcome (P < 0.005 for both) (B) Individual patients’ LGI1‐IgG4 index per final mRS score at last follow‐up.
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