e u r o p e a n j o u r n a l o f p a e d i a t r i c n e u r o l o g y x x x ( 2 0 1 7 ) 1 e4

Official Journal of the European Paediatric Neurology Society

Case study

Limbic encephalitis with LGI1 antibodies in a 14year-old boy M. Schimmel a,*, M.C. Fru¨hwald a, C.G. Bien b,c a

Children's Hospital Augsburg, Section of Neuropediatrics, Klinikum Augsburg, Germany Epilepsy Centre Bethel, Krankenhaus Mara, Bielefeld, Germany c Laboratory Krone, Bad Salzuflen, Germany b

article info

abstract

Article history:

Limbic encephalitis (LE) with antibodies against leucine-rich glioma inactivated protein 1

Received 22 April 2017

(LGI1) is an auto-antibody mediated disorder with characteristic symptoms as dysfunction

Received in revised form

of memory, faciobrachial dystonic seizures and neuropsychiatric symptoms as emotional

12 August 2017

lability.

Accepted 22 August 2017

Limbic encephalitis with LGI1 antibodies has been known so far as a disease of adults. We describe the case of a 14-year-old boy presenting with typical dysfunction of memory

Keywords:

and LGI1 antibodies. To the best of our knowledge, this is the youngest patient with LGI1

Limbic encephalitis

antibody mediated limbic encephalitis described so far.

LGI1 antibodies

Improved knowledge of this autoimmune syndrome in children and adolescents permit

Immunotherapy

rapid immunomodulatory treatment, which could help to prevent irreversible lesions, such

Memory dysfunction

as hippocampal atrophy.

Hippocampal atrophy

© 2017 European Paediatric Neurology Society. Published by Elsevier Ltd. All rights reserved.

1.

Introduction

Limbic encephalitis (LE) with antibodies against leucine-rich glioma-inactivated 1 protein (LGI1) is an auto-antibody mediated disorder with characteristic symptoms as faciobrachial dystonic seizures,4 temporal lobe seizures, dysfunction of memory, and neuropsychiatric symptoms as emotional lability. It has been described in adults so far.3,6,7 Within the existing series with >10 cases, the youngest patient has been 21 years old.7 We present the case of a 14-year-old boy with typical symptoms of limbic encephalitis as dysfunction of memory and detection of LGI1 antibodies.

To the best of our knowledge, this is the youngest patient with this condition described to date.

2.

Case study

We present the case of a 14-year-old boy with subacutely evolving dysfunction of recent memory. The first signs of memory problems became obvious with therapy of his preexisting diabetes mellitus. Having been familiar with the insulin injection system, he forgot simple details on how to use it. He became emotionally labile, had suicidal thoughts and developed kleptomania. In the course of the disease, the boy

* Corresponding author. Children's Hospital Augsburg, Section of Neuropediatrics, Stenglinstr. 2, 86156 Augsburg, Germany. E-mail address: [email protected] (M. Schimmel). http://dx.doi.org/10.1016/j.ejpn.2017.08.004 1090-3798/© 2017 European Paediatric Neurology Society. Published by Elsevier Ltd. All rights reserved. Please cite this article in press as: Schimmel M, et al., Limbic encephalitis with LGI1 antibodies in a 14-year-old boy, European Journal of Paediatric Neurology (2017), http://dx.doi.org/10.1016/j.ejpn.2017.08.004

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e u r o p e a n j o u r n a l o f p a e d i a t r i c n e u r o l o g y x x x ( 2 0 1 7 ) 1 e4

Fig. 1 e AeD: Serial fluid-attenuated inversion recovery magnetic resonance imaging revealing development of left sided hippocampal sclerosis (arrows). In D, the loss of the internal structure of the right hippocampus and a slightly increased signal suggests that the right hippocampus, too, has become sclerotic (dashed arrow). E: LGI1 antibody titres over time in relation to the immunological therapies and disability as measured by the modified Rankin Scale. Yellow: methylprednisolone pulse. Red: plasma exchanges. Orange: oral prednisolone. Blue: mycophenolate mofetil. Open squares: LGI1 serum antibody titres

Limbic encephalitis with LGI1 antibodies in a 14-year-old boy.

Limbic encephalitis (LE) with antibodies against leucine-rich glioma inactivated protein 1 (LGI1) is an auto-antibody mediated disorder with character...
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