Clinical and electrographic characteristics of seizures in LGI1-antibody encephalitis

Abstract

Purpose

The purpose of this study was to analyze the clinical and electrographic characteristics of seizures in LGI1-antibody encephalitis.

Methods

The methods utilized in this study were prospective analysis of the clinical manifestations, types of seizures, electroencephalogram (EEG), adjuvant examination, treatment and prognosis of 19 cases of LGI1-antibody encephalitis diagnosed from January 2017 to February 2018 in First Affiliated Hospital of Zhengzhou University, and reviewed related literatures.

Results

The 15/19 (79%) patients were male, and the average onset age was 58 years (23–82). The following cases were observed: 17 (89%) with epilepsy seizures, 14 (73%) with mental disorders, and 13 (68%) with cognitive impairment. Types of epilepsy were including focal aware seizures, focal-impaired awareness seizures, focal to bilateral tonic–clonic seizures, and status epilepticus. The motor events were most commonly clonus or automatisms, and the sensory events were frequently body shuddering. The 13 patients had faciobrachial dystonic seizures (FBDS); the median frequency was 48 per day (range 5–180). In some video-EEGs, multifocal ictal epileptiform discharges from frontal, temporal, and apical regions, and interictal slow wave activity were observed in patients. Normal EEG appeared in all patients during FBDS. Five patients had hyponatremia, and brain magnetic resonance imaging (MRI) results of 5 cases were abnormal. All patients were treated with antiepileptic drugs and immunotherapy, and their clinical symptoms were improved. During the follow-up period, 13 patients recovered basically, and 6 patients relapsed. One patient died of status epilepticus after relapse.

Conclusions

Faciobrachial dystonic seizure and various types of epileptic seizures are characteristic manifestations of LGI1-antibody encephalitis, which can assist in early diagnosis. Once this has been diagnosed, antiepileptic drugs and immunotherapy should be given as soon as possible to the patient.