An Unusual Case of Refractory Seizures

Area of Science:

• Neurology
• Immunology
• Endocrinology

Background:

• Autoimmune encephalitis presents with diverse neurological symptoms, often including seizures and altered mental status.
• Leucine-rich glioma-inactivated 1 (LGI1) antibody encephalitis is a rare autoimmune condition associated with specific neurological and electrolyte abnormalities.
• Recurrent hyponatremia and hypoglycemia can complicate the diagnosis and management of neurological disorders.

Purpose of the Study:

• To report a case of LGI1 antibody encephalitis presenting with nonconvulsive seizures and severe electrolyte disturbances.
• To discuss the diagnostic challenges and treatment strategies for this rare condition.
• To evaluate the efficacy of rituximab in managing refractory LGI1 antibody encephalitis.

Main Methods:

• A 54-year-old female patient with recurrent altered sensorium, hyponatremia, and hypoglycemia was evaluated.
• Diagnostic workup included EEG, CSF analysis, and serum autoimmune encephalitis panel.
• Treatment involved IV immunoglobulin (IVIg), fluid restriction, desmopressin, and ultimately, two courses of rituximab.

Main Results:

• The patient tested positive for LGI1 antibodies.
• Initial treatments with IVIg and management of SIADH-induced hyponatremia provided only partial improvement.
• Two rituximab infusions led to significant improvement in sensorium, cessation of seizure activity, and better daily functioning.

Conclusions:

• LGI1 antibody encephalitis can manifest with nonconvulsive seizures and challenging electrolyte abnormalities.
• Rituximab demonstrated significant efficacy in this refractory case, offering an alternative immunosuppressive strategy.
• Early recognition and targeted immunosuppression are crucial for managing LGI1 antibody encephalitis.