Clinical manifestations in anti-LGI1 encephalitis cases with and
without teratoma
The clinical features of this case of teratoma-associated anti-LGI1
encephalitis and of the nine other cases without teratoma are summarized
in Table 2.
Our case with teratoma shared many
clinical features with those subjects without teratoma (NT group),
including 1) age at onset of 48, near the average of 47.3 years in the
NT group; 2) hyponatremia, as seen in 78% of the NT group; 3) normal
CSF cell count and protein, as seen in 78% of the NT group; 4) positive
LGI1 antibody, as seen in blood and/or CSF of all subjects; 5)
hippocampal hyperintensity on MRI, as seen in 89% of the NT group; 6)
slow waves on EEG, as seen in 33% of the NT group; 7) cognitive
impairment and sleep disorder, seen in 67% of the NT group; 8) residual
cognitive impairment >1 year after admission, as seen in
67% of the NT group; and 9) only mild neurological disability during
follow-up: the mRS score was 1 in the patient with teratoma, as compared
to <=2 in 67% of the NT group.
However, there are also four key points in which the patient with
teratoma significantly differed from those without. First, she presented
with chronic anxiety as a prominent symptom; only one patient in the NT
group had anxiety as a symptom, and this was acute anxiety beginning
simultaneously with FBDS. Second, her anxiety was persistent, lasting
for nine months from onset; the NT patient with acute anxiety had
resolution of this feature by two months follow up. Third, the patient
with teratoma developed convulsive SE during her course, but never had
FBDS, as was seen in several of the NT group in both the acute stage of
their disease and during follow up.