ArticleFrontiers in neurology
Middle-aged predominance and diagnostic delays in anti-LGI1 encephalitis: the role of antibody testing.
Article in Frontiers in neurology. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: This study aimed to investigate the clinical characteristics of anti-leucine-rich glioma-inactivated 1 (LGI1) antibody encephalitis and to identify significant risk factors associated with long-term functional prognosis. Methods: We retrospectively analyzed the clinical data of 20 patients diagnosed with anti-LGI1 encephalitis at the Affiliated Hospital of Xuzhou Medical University from January 2021 to October 2024. All patients underwent a 12-month follow-up. Functional outcomes were assessed using the modified Rankin Scale (mRS) at 12 months post-discharge and were dichotomized into favorable (mRS ≤ 2) and poor (mRS > 2) outcome groups. Results: Of the 20 patients (14 males and 6 females; mean age: 57 years), seizures represented the most prevalent chief complaint at onset (70%). Cognitive impairment was noted as an initial presenting symptom in 45% of patients, whereas its cumulative incidence reached 95% throughout the entire disease course. Pathognomonic faciobrachial dystonic seizures (FBDS) occurred in 40% of cases, and hyponatremia was present in 70% of the cohort. Anti-LGI1 antibodies were detected in 95% (19/20) of serum samples and 90% (18/20) of cerebrospinal fluid (CSF) samples. Notably, 40% of patients exhibited unremarkable cranial MRI findings, and 55% demonstrated normal CSF protein levels upon admission. At the 12-month follow-up, 80% of patients achieved favorable functional recovery. Univariate analysis revealed that advanced age ( Conclusion: The high frequency of unremarkable results in initial ancillary investigations, such as MRI and routine CSF analysis, often leads to substantial diagnostic and therapeutic delays in anti-LGI1 encephalitis. Advanced age, diagnostic latency, and high antibody titers are critical predictors of poor prognosis. Early and simultaneous antibody screening in both serum and CSF is essential for narrowing the diagnostic window and optimizing long-term neurological recovery.
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