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Clinical diagnosis of LGI1 antibody encephalitis in an 83-year-old woman
  1. Jonathan E Attwood1,2,
  2. Saniya Naseer3,
  3. Sophia Michael2,4 and
  4. Josie Riley3
  1. 1Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, Oxfordshire, UK
  2. 2Department of Neurology, Oxford University Hospitals NHS Foundation Trust, Oxford, Oxfordshire, UK
  3. 3Department of Geratology, Oxford University Hospitals NHS Foundation Trust, Oxford, Oxfordshire, UK
  4. 4Nuffield Department of Clinical Neurosciences, Oxford Autoimmune Neurology Group, University of Oxford, Oxford, Oxfordshire, UK
  1. Correspondence to Dr Jonathan E Attwood; jonathan.attwood{at}ndcn.ox.ac.uk

Abstract

An 83-year-old woman was referred to hospital with a 2-week history of short-lived episodic unpleasant sensations in her head and running down her body. This was accompanied by new short-term memory impairment and arm spasms. Initial investigations including blood tests and brain imaging did not reveal the diagnosis. The patient developed an increasing frequency of abnormal movements of her face and arm. These were clinically recognised as faciobrachial dystonic seizures (FBDS). FBDS are pathognomonic of an autoimmune encephalitis caused by an antibody directed against leucine-rich glioma-inactivated 1 (LGI1). The clinical diagnosis resulted in treatment with immunotherapy, leading to cessation of seizures and rapid cognitive recovery. Later, the predicted serology was confirmed. This reversible and under-recognised cause of cognitive impairment, typically affecting elderly patients, can be diagnosed clinically to enable early and effective treatment.

  • geriatric medicine
  • memory disorders
  • epilepsy and seizures
  • immunology

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Footnotes

  • JEA and SN are joint first authors.

  • Contributors All authors were involved in the care of the patient, conceived the idea of the report, performed the literature search, contributed to writing and approved the final version of the manuscript. JEA and SN contributed equally to this paper (joint first authors).

  • Funding SM is funded by UCB (Union Chimique Belge) UK (HMR01470).

  • Competing interests None declared.

  • Patient consent for publication Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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