Anti-LGI1 encephalitis: clinical presentation, imaging features, and prognostic analysis

To investigate the clinical features, neuroimaging characteristics, and prognosis of patients with anti-leucine-rich glioma-inactivated 1 (LGI1) antibody associated encephalitis.

We conducted a retrospective study of 87 patients diagnosed with anti-LGI1 encephalitis during the acute phase, admitted to two tertiary hospitals in China between January 2022 and September 2024. Clinical data, neuroimaging findings, and follow-up outcomes were systematically analyzed.

The primary clinical manifestations included memory impairment, epileptic seizures, psychiatric and behavioral disturbances, sleep dysfunction, involuntary movements, faciobrachial dystonic seizures (FBDS), and autonomic dysfunction. Among 53 patients tested for thyroid function, 9 (17.0%) exhibited abnormalities. Hyponatremia was observed in 41 of 82 patients (50.0%), and hyperhomocysteinemia (HHCY) in 23 of 80 (28.7%). Among 68 patients who underwent cerebrospinal fluid (CSF) analysis, elevated intracranial pressure was observed in 10 (14.7%), pleocytosis in 22 (32.4%), and elevated protein levels in 27 (39.7%). Electrocardiographic abnormalities were identified in 26 of 42 patients (61.9%) without prior cardiovascular disease. MRI abnormalities were present in 75 of 80 patients (93.8%), most commonly affecting the temporal lobe (55.0%), hippocampus (51.2%), and amygdala (11.2%). PET imaging in 39 patients frequently revealed hypermetabolism in the basal ganglia and temporal lobe. All patients received first-line immunotherapy. Of the 63 patients with follow-up data, 59 (93.7%) achieved favorable outcomes.

Anti-LGI1 encephalitis is an immune-mediated autoimmune disorder characterized by memory impairment, epileptic seizures, FBDS, psychiatric and behavioral disturbances, autonomic dysfunction, hyponatremia, and HHCY. Immunotherapy is generally effective, leading to favorable prognosis in the majority of patients.