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. 2020 Jul 30:11:696.
doi: 10.3389/fneur.2020.00696. eCollection 2020.

Sleep Disorders in Leucine-Rich Glioma-Inactivated Protein 1 and Contactin Protein-Like 2 Antibody-Associated Diseases

Nan Lin  1 , Honglin Hao  1 , Hongzhi Guan  1 , Heyang Sun  1 , Qing Liu  1 , Qiang Lu  1 , Liri Jin  1 , Haitao Ren  1 , Yan Huang  1
Affiliations

Sleep Disorders in Leucine-Rich Glioma-Inactivated Protein 1 and Contactin Protein-Like 2 Antibody-Associated Diseases

Nan Lin et al. Front Neurol. .

Erratum in

Abstract

Objective: Sleep disorders are common in voltage-gated potassium channel complex antibody (VGKC-Ab) diseases. The aim was to investigate the sleep disturbances and polysomnography (PSG) characteristics in patients with VGKC-Ab-associated diseases. Methods: Twenty-seven patients with leucine-rich glioma-inactivated protein 1 antibody (LGI1-Ab) encephalitis, seven patients with contactin protein-like 2 antibody (Caspr2-Ab)-associated diseases, and 14 healthy controls with at least one PSG or actigraphy recording were recruited at Peking Union Medical College Hospital from January 2014 to July 2019. Results: Sleep disorders including insomnia, hypersomnia, rapid eye movement (REM) sleep behavior disorder (RBD), periodic limb movements in sleep (PLMS), agrypnia excitata, and obstructive sleep apnea syndrome were observed. Twenty-one PSG recordings from patients with LGI1-Ab encephalitis demonstrated a decrease in total sleep time (TST) (median 365.5, range 184.5-495.5 min), sleep efficiency (70.0%, 47-92%), N3 sleep (9.7%, 0-32.9%), and REM sleep (9.9%, 0.4-27.9%). Of five patients with Caspr2-Ab-associated diseases, TST was found to be 329.5 (167.0-377.5 min), and sleep efficiency was found to be 61.7% (34.6-71.7%). The percentage for N3 and REM sleep was found to be 15.0% (0-34.6%) and 12.7% (0-22.2%), respectively. Both RBD and PLMS were observed more frequently in patients with LGI1-Ab encephalitis. We identified status dissociatus (SD) in five (23.8%) patients with LGI1-Ab encephalitis and two (40%) patients with Caspr2-Ab diseases. The former is more likely to have simple limb movements rather than complex movements, which mimic the contents of their dreams. Continuous insomnia was more common in patients with Caspr2-Ab diseases than patients with LGI1-Ab encephalitis. Patients reported clinical and PSG improvements following immunotherapy. Conclusion: Sleep disorders in patients with VGKC-Ab-associated diseases include decreased TST and poor sleep efficiency. Our studies provide evidence of SD in patients with LGI1-Ab encephalitis.

Keywords: Caspr2 antibody-associated diseases; LGI1 antibody encephalitis; polysomnography; sleep disorders; states dissociate.

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Figures

Figure 1
Figure 1
Sleep histogram. (A) Sleep histogram in a patient with LGI1-antibody encephalitis revealed severe impaired sleep structure, short REM sleep episodes mixed with NREM sleep, and no N3 sleep. (B) Follow-up PSG showed identified sleep architecture and stable REM sleep. (C) Sleep histogram in a Morvan's syndrome patient showed absence of REM sleep and frequent shifts between wake and NREM sleep. LGI1, leucine-rich glioma-inactivated protein 1; REM, rapid eye movement; NREM, non-rapid eye movement; PSG, polysomnography.
Figure 2
Figure 2
Polygraphic recording in a patient with LGI1-antibody encephalitis who had status dissociatus showed dominated slow eye movements interspersed with rapid eye movements. LGI1, leucine-rich glioma-inactivated protein 1.
Figure 3
Figure 3
Actigraphy reports. (A) Actigraphy in a patient with LGI1-antibody encephalitis who had status dissociatus showed 24-h day–night motor rhythmicity. (B) Actigraphy in a patient with Caspr2-antibody-associated diseases showed continuous insomnia. LGI1, leucine-rich glioma-inactivated protein 1.
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References

    1. Liguori R, Vincent A, Clover L, Avoni P, Plazzi G, Cortelli P, et al. . Morvan's syndrome: peripheral and central nervous system and cardiac involvement with antibodies to voltage-gated potassium channels. Brain. (2001) 124:2417–26. 10.1093/brain/124.12.2417 - DOI - PubMed
    1. Barber PA, Anderson NE, Vincent A. Morvan's syndrome associated with voltage-gated K+ channel antibodies. Neurology. (2000) 54:771–2. 10.1212/WNL.54.3.771 - DOI - PubMed
    1. Hart IK, Waters C, Vincent A, Newland C, Beeson D, Pongs O, et al. . Autoantibodies detected to expressed K+ channels are implicated in neuromyotonia. Ann Neurol. (1997) 41:238–46. 10.1002/ana.410410215 - DOI - PubMed
    1. Shillito P, Molenaar PC, Vincent A, Leys K, Zheng W, van den Berg RJ, et al. . Acquired neuromyotonia: evidence for autoantibodies directed against K+ channels of peripheral nerves. Ann Neurol. (1995) 38:714–22. 10.1002/ana.410380505 - DOI - PubMed
    1. Buckley C, Oger J, Clover L, Tuzun E, Carpenter K, Jackson M, et al. . Potassium channel antibodies in two patients with reversible limbic encephalitis. Ann Neuro. (2001) 50:73–8. 10.1002/ana.1097 - DOI - PubMed