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Multicenter Study
. 2025 May;31(5):e70414.
doi: 10.1111/cns.70414.

Clinical, Electroencephalogram and Imaging Characteristics of Patients With Anti-LGI1 Antibody Encephalitis: A Multicenter Cohort Study

Affiliations
Multicenter Study

Clinical, Electroencephalogram and Imaging Characteristics of Patients With Anti-LGI1 Antibody Encephalitis: A Multicenter Cohort Study

Yang Zhao et al. CNS Neurosci Ther. 2025 May.

Abstract

Objectives: To summarize the clinical, electroencephalogram (EEG), and imaging characteristics of patients with anti-leucine-rich glioma-inactivated 1 autoimmune encephalitis (LGI1-AE) and provide a reference for clinical diagnosis and treatment.

Methods: We retrospectively analyzed 88 patients diagnosed with LGI1-AE between January 2018 and April 2024 in the Department of Neurology, Huashan Hospital, Fudan University, and the First Hospital of Jilin University.

Results: This retrospective study analyzed 88 patients diagnosed with LGI1-AE. The initial clinical presentation predominantly featured rapidly progressive cognitive impairment (RPCI) (51.1%) and seizures (50%). Brain magnetic resonance imaging and 18 F-fluorodeoxyglucose positron emission tomography (18F-FDG PET) indicated predominant lesion localization in the unilateral or bilateral temporal lobe and/or basal ganglia. Abnormal EEG was observed in 66 cases (79.5%). LGI1-AE cases had increased power in the low-frequency bands (δ and θ) compared to normal controls. Low-frequency band (δ and θ) power in T3 and Fz channels was positively correlated with LGI1 antibody titers in cerebrospinal fluid (CSF). Spearman correlation analysis showed that baseline modified Rankin Scale (mRS) scores were correlated with serum antibody titers and CSF antibody titers.

Conclusions: Baseline mRS scores and low-frequency power in the frontotemporal region showed a positive correlation with anti-LGI1 antibody titers, suggesting that antibody levels may reflect disease severity in LGI1 autoimmune encephalitis. Further studies are warranted to validate these associations in prospective multicenter cohorts.

Keywords: anti‐LGI1 encephalitis; autoimmune disease; behavioral and psychological symptoms; electroencephalogram; rapidly progressing cognitive impairment; seizures.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

FIGURE 1
FIGURE 1
Bilateral hippocampal abnormalities on MRI in LGI1‐AE. Irregular patchy abnormal signals are seen bilaterally in the hippocampal region of the deep temporal lobes, with slightly low signals in T1WI (A) and slightly high signals in T2WI (B), T2WI‐FLAIR (C) and DWI (D).
FIGURE 2
FIGURE 2
Bilateral temporal hypermetabolism on 18F‐FDG PET in LGI1‐AE. 18F‐FDG PET demonstrates bilateral hypermetabolism in the deep temporal lobes adjacent to the hippocampus.
FIGURE 3
FIGURE 3
Power values of each frequency band in the LGI1‐AE group and NC group. (A) Comparison of δ‐band power values between the LGI1‐AE group and NC group. (B) Comparison of θ‐band power values between the LGI1‐AE group and NC group. *0.01 ≤ p < 0.05; **0.001 ≤ p < 0.01; ***p < 0.001. LGI1‐AE, LGI1 antibody‐associated autoimmune encephalitis; NC, normal control.
FIGURE 4
FIGURE 4
Visualization of PSD results in the LGI1‐AE group and NC group. (A) PSD distribution of NC group and LGI1‐AE group in the θ band. (B) PSD distribution of NC group and LGI1‐AE group in the δ band. PSD, power spectral density.
FIGURE 5
FIGURE 5
Correlation analysis of 19‐channel spectral power and clinical indicators. (A) Spearman correlation analysis plot of the δ‐band power versus other metrics across 19 channels. (B) Spearman correlation analysis plot of the θ‐band power versus other metrics across 19 channels. *0.01 ≤ p < 0.05; **0.001 ≤ p < 0.01;***p < 0.001. Anti‐LGI1 titer, anti‐LGI1 antibody titer; ICP, intracranial pressure.

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