DOI QR코드

DOI QR Code

Anti-LGI1 Antibody Encephalitis

양극성장애로 오인된 LGI1 자가면역성뇌염

  • Kim, Eun Soo (Department of Psychiatry, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine) ;
  • Lee, HeeJun (Department of Psychiatry, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine) ;
  • Jeon, Sang Won (Department of Psychiatry, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine) ;
  • Cho, Sung Joon (Department of Psychiatry, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine)
  • 김은수 (성균관대학교 의과대학 강북삼성병원 정신건강의학교실) ;
  • 이희준 (성균관대학교 의과대학 강북삼성병원 정신건강의학교실) ;
  • 전상원 (성균관대학교 의과대학 강북삼성병원 정신건강의학교실) ;
  • 조성준 (성균관대학교 의과대학 강북삼성병원 정신건강의학교실)
  • Received : 2020.03.05
  • Accepted : 2020.07.08
  • Published : 2020.10.31

Abstract

Leucine rich glioma inactivated (LGI1) encephalitis is an uncommon neurological disorder rarely encountered in clinical practice. However, it is a potentially fatal autoimmune syndrome that can decrease the level of consciousness, possibly progressing to coma. Additionally, unless diagnosed and promptly treated, it can cause permanent cognitive impairment. Since LGI1 encephalitis can initially present with psychiatric symptoms, there can be delays in reaching a proper diagnosis. This report describes a case of a 47-year-old woman with LGI1 antibodies-associated limbic encephalitis who initially presented with psychosis. Her blood tests were normal and no MRI and EEG abnormalities were found. Cerebrospinal fluid analysis was negative for other possible infectious causes. Three months after admission, she was found to be LGI1 antibody positive. LGI1 encephalitis should be suspected in patients with symptoms such as memory loss, confusion, seizures, and psychiatric symptoms. Prompt diagnosis and treatment of LGI1 encephalitis are warranted because prognosis becomes worse when such actions are delayed.

Keywords

References

  1. Tuzun E, Dalmau J. Limbic encephalitis and variants: classification, diagnosis and treatment. Neurologist 2007;13:261-271. https://doi.org/10.1097/NRL.0b013e31813e34a5
  2. Brierley JB, Corsellis JAN, Hierons R, Nevine S. Subacute encephalitis of later adult life. Mainly affecting the limbic areas. Brain 1960;83:357-368. https://doi.org/10.1093/brain/83.3.357
  3. Ramanathan S, Mohammad SS, Brilot F, Dale RC. Autoimmune encephalitis: recent updates and emerging challenges. J Clin Neurosci 2014;21:722-730. https://doi.org/10.1016/j.jocn.2013.07.017
  4. Shin YW, Lee ST, Shin JW, Moon J, Lim JA, Byun JI, et al. VGKCcomplex/LGI1-antibody encephalitis: clinical manifestations and response to immunotherapy. J Neuroimmunol 2013;265:75-81. https://doi.org/10.1016/j.jneuroim.2013.10.005
  5. Anderson NE, Barber PA. Limbic encephalitis-a review. J Clin Neurosci 2008;15:961-971. https://doi.org/10.1016/j.jocn.2007.12.003
  6. Florance NR, Davis RL, Lam C, Szperka C, Zhou L, Ahmad S, et al. Anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis in children and adolescents. Ann Neurol 2009;66:11-18. https://doi.org/10.1002/ana.21756
  7. Dubey D, Pittock SJ, Kelly CR, McKeon A, Lopez-Chiriboga AS, Lennon VA, et al. Autoimmune encephalitis epidemiology and a comparison to infectious encephalitis. Ann Neurol 2018;83:166-177. https://doi.org/10.1002/ana.25131
  8. Kim H, Kim B, Hwang J, Lee Y, Lee ST, Kang JK. Anti-LGI1 antibody autoimmune encephalitis which manifests faciobrachial dystonic seizure. J Korean Neurol Assoc 2014;32:22-25.
  9. Park IW, Kim YB, Chung PW, Moon HS, Suh BC, Yoon WT, et al. Anti-N-methyl-D-aspartate receptor encephalitis after herpes simplex virus infection. J Korean Neurol Assoc 2018;36:93-96. https://doi.org/10.17340/jkna.2018.2.6
  10. Sunwoo JS. Corticosteroid Treatment in Autoimmune encephalitis. Neurocrit Care 2017;10:60-68. https://doi.org/10.18700/jnc.170029
  11. Jang Y, Lee ST, Lim JA, Kim TJ, Jun JS, Moon J, et al. Psychiatric symptoms delay the diagnosis of anti-LGI1 encephalitis. J Neuroimmunol 2018;317:8-14. https://doi.org/10.1016/j.jneuroim.2018.02.005
  12. Kayser MS, Titulaer MJ, Gresa-Arribas N, Dalmau J. Frequency and characteristics of isolated psychiatric episodes in anti-N-methyl-daspartate receptor encephalitis. JAMA Neurol 2013;70:1133-1139. https://doi.org/10.1001/jamaneurol.2013.3216
  13. Wang D, Hao Q, He L, He L, Wang Q. LGI1 antibody encephalitisdetailed clinical, laboratory and radiological description of 13 cases in China. Compr Psychiatry 2018;81:18-21. https://doi.org/10.1016/j.comppsych.2017.11.002
  14. Venkatesan A, Tunkel AR, Bloch KC, Lauring AS, Sejvar J, Bitnun A, et al. Case definitions, diagnostic algorithms, and priorities in encephalitis: consensus statement of the international encephalitis consortium. Clin Infect Dis 2013;57:1114-1128. https://doi.org/10.1093/cid/cit458
  15. Lancaster E. The diagnosis and treatment of autoimmune encephalitis. J Clin Neurol 2016;12:1-13. https://doi.org/10.3988/jcn.2016.12.1.1
  16. Zuliani L, Graus F, Giometto B, Bien C, Vincent A. Central nervous system neuronal surface antibody associated syndromes: review and guidelines for recognition. J Neurol Neurosurg Psychiatry 2012;83:638-645. https://doi.org/10.1136/jnnp-2011-301237
  17. Chapman MR, Vause HE. Anti-NMDA receptor encephalitis: diagnosis, psychiatric presentation, and treatment. Am J Psychiatry 2011;168:245-251. https://doi.org/10.1176/appi.ajp.2010.10020181
  18. Zandi MS, Irani SR, Lang B, Waters P, Jones PB, McKenna P, et al. Disease-relevant autoantibodies in first episode schizophrenia. J Neurol 2011;258:686-688. https://doi.org/10.1007/s00415-010-5788-9