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. 2021 Dec 17:12:772096.
doi: 10.3389/fimmu.2021.772096. eCollection 2021.

Positive LGI1 Antibodies in CSF and Relapse Relate to Worse Outcome in Anti-LGI1 Encephalitis

Li-Li Cui  1 , Johannes Boltze  2 , Yan Zhang  1   3
Affiliations

Positive LGI1 Antibodies in CSF and Relapse Relate to Worse Outcome in Anti-LGI1 Encephalitis

Li-Li Cui et al. Front Immunol. .

Abstract

Objective: This single-center study was conducted in a cohort of patients with anti-LGI1 encephalitis to investigate the factors related to their functional recovery.

Methods: We retrospectively collected the clinical information of patients admitted to Xuanwu Hospital from January 2014 until December 2019, and followed up for at least 12 months.

Results: A total of 67 patients were included, and 57 completed the 12-month follow-up. Most of the patients (55/57, 96.5%) achieved functional improvement after immunotherapy, and 26 (45.6%) became symptom-free. Compared to patients with complete recovery, patients with partial or no recovery had significantly higher incidences of consciousness disorders (25.8% vs. 0%, P<0.05) and positive LGI1 antibodies in cerebrospinal fluid (CSF) (71.0% vs. 46.2%, P<0.05). These patients also had a lower Barthel Index both upon admission and at discharge, as well as a higher incidence of relapse (25.8% vs. 3.8%; P<0.05 each). Univariate logistic regression showed that positive LGI1 antibodies in CSF and relapse were associated with incomplete recovery at 1-year follow-up (both P<0.05), but only relapse remained statistically significant after multivariate logistic regression (P=0.034).

Conclusion: Patients with LGI1 antibodies in CSF and those who relapsed were more likely to experience worse outcome. Early recognition of these patients, combined with more aggressive immunotherapy may result in better recovery.

Keywords: CSF antibody; anti-LGI1 encephalitis; outcome; relapse; risk factor.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Typical MRI of anti-LGI1 encephalitis patients. (A–E) MRI of a patient at 1 month after disease-onset, showing high T2 (A) and T2/FLAIR [(B–D axial, (E) coronal] signals in the left hippocampus (white arrows). (F–J) MRI of a patient at 6 months after disease-onset, showing moderately elevated T2 (A) and T2/FLAIR [(B–D) axial, (E) coronal] signals in both hippocampi (white arrows) as well as bilateral hippocampal atrophy.
Figure 2
Figure 2
Typical EEG of a patient with anti-LGI1 encephalitis. The inter-ictal EEG of a patient shows sharp-wave activity in the sphenoid electrodes.
Figure 3
Figure 3
Modified ranking scale (mRS) of patients with anti-LGI1encephalitis at the 12-month follow-up.
Figure 4
Figure 4
ROC curves of age and Barthel Index (BI) at discharge to predict relapse.
See this image and copyright information in PMC

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