An adolescent case of limbic encephalitis with anti leucine-rich glioma inactivated 1 antibodies

Abstract

Background: Limbic encephalitis associated with leucine-rich glioma inactivated 1 (LGI1) antibodies can initially have either neurological or psychiatric manifestation. Subject and methods: The paper describes a case of a 14-year old girl with LGI1 antibodiesassociated limbic encephalitis with initial symptoms suggesting psychotic disturbances. Results: The magnetic resonance imaging (MRI) of the head was normal and the electroencephalography (EEG) presented low voltage with inter-hemispheric asymmetry and paroxysmal series of delta and theta waves. Blood antibody tests detected the presence of the LGI1 antibodies. Apart from psychotic symptoms, the patient also presented epileptic seizures, instability of the autonomous nervous system, dysphagia and catatonia. Initial treatment with antipsychotics resulted in the neuroleptic malignant syndrome (NMS). Significant improvement of the patient’s condition appeared upon the administration of immunoglobulins and methylprednisolone. Conclusions: Diagnosis and treatment of the limbic encephalitis in the young patient may be difficult due to a variety of reasons. A determination of anti-LGI1 antibodies also in adolescents presenting psychotic symptoms may be considered.