Tonic seizures: A diagnostic clue of anti-LGI1 encephalitis?
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Seizures and memory loss are common features of anti-LGI1 limbic encephalitis,1 a recently described autoimmune encephalitis, previously attributed to voltage-gated potassium channel antibodies (VGKC-ab).2,3
Abnormal involuntary movements are frequently seen in patients diagnosed with anti-LGI1 limbic encephalitis. However, to date it is not clear if these abnormal movements represent seizures or an extrapyramidal movement disorder. Here we describe 3 patients with anti-LGI1 limbic encephalitis, who presented with severe movement abnormalities that were associated with ictal EEG changes.
Methods.
We present 3 female patients (ages 80, 46, and 72) with similar features.
Clinical features.
All patients developed abnormal movements of face, shoulders, arms, or legs (videos 1–3 on the Neurology® Web site at www.neurology.org). These strong, massive movements were slightly slower than typical myoclonus, occurring 5 to 100 times per day. Their consciousness was preserved during the movements.
EEG.
Continuous video-EEG recordings showed that the longer movements were clearly associated with generalized EEG electrodecremental events (EDEs), usually preceding the onset of movement by approximately 500 msec (figure), a pattern typical of epileptic tonic …
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Letters: Rapid online correspondence
- Tonic seizures: A diagnostic clue of anti-LGI1 encephalitis?
- Pasquale Striano, Research Assistant, Muscular and Neurodegenerative Diseases Unit, Institute "G. Gaslini", University of Genova, Genova;pstriano@email.it
- Vincenzo Belcastro, and Salvatore Striano
Submitted August 23, 2011 - Tonic seizures: A diagnostic clue of anti-LGI1 encephalitis?
- Sarosh R. Irani, Clinical Research Fellow, Nuffield department of Clinical Neurosciences, Oxford Universitysaroshirani@doctors.net.uk
- Jonathan M Schott2 (2.Dementia Research Centre, Institute of Neurology UCL), Angela Vincent1 (1.Nuffield Department of Neurosciences, University of Oxford) and Shelagh JM Smith3 (3.Dept of Clinical Neurophysiology, The National Hospital for Neurology
Submitted August 23, 2011 - Reply from the authors
- Danielle Andrade,, 5W-445, 399 Bathurst St, Toronto, ON, Canada, M5T 2S8Danielle.Andrade@uhn.on.ca
- Peter Tai, Josep Dalmau and Richard Wennberg
Submitted August 23, 2011
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