Autoimmune encephalitis associated with anti-recoverin antibodies

Area of Science:

• Neurology
• Immunology
• Oncology

Background:

• Autoimmune encephalitis (AE) encompasses autoimmune disorders causing epilepsy and neuropsychiatric symptoms.
• Anti-recoverin antibodies, typically linked to paraneoplastic retinopathy, are rarely associated with neurological and psychiatric conditions.
• Few cases of anti-recoverin antibody-associated limbic AE have been reported.

Purpose of the Study:

• To report a case of anti-recoverin antibody-positive limbic AE in an adult.
• To illustrate the diagnostic value of anti-recoverin antibody testing in cerebrospinal fluid (CSF).
• To provide insights into the management and 2-year prognosis of this rare condition.

Main Methods:

• A 33-year-old female presented with temporal epilepsy, insomnia, and cognitive impairment.
• Diagnostic work-up included EEG, MRI, and testing for anti-recoverin antibodies in blood and CSF.
• Treatment involved intravenous methylprednisolone, intravenous immunoglobulin (IVIG), and anti-epileptic drugs (levetiracetam, lamotrigine).

Main Results:

• The patient was diagnosed with definite limbic AE, with strongly positive anti-recoverin antibodies in blood and CSF.
• Brain MRI revealed bilateral hippocampal and thalamic lesions.
• After 2 years of follow-up, the patient showed clinical and radiological improvement, with persistent but reduced antibody positivity.

Conclusions:

• Testing for anti-recoverin antibodies in CSF is valuable for diagnosing rare cases of AE.
• Anti-recoverin antibody-related AE is a treatable cause of adult subacute encephalopathy and epilepsy.
• Prompt management combining immunotherapy and anti-epileptic drugs is crucial for mitigating long-term sequelae.