Telemedicine assessment of long-term cognitive and functional status in anti-leucine-rich, glioma-inactivated 1 encephalitis

Solà-Valls, Núria; Ariño, Helena; Escudero, Domingo; Solana, Elisabeth; Lladó, Albert; Sánchez‐Valle, Raquel; Blanco, Yolanda; Sáiz, Albert; Dalmau, Josep; Graus, Francesc

doi:10.1212/nxi.0000000000000652

Cited by 33 publications

(51 citation statements)

References 32 publications

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“…The Abs involved are mostly LGI1, which is an anti-neuronal surface Ab, accounting for 30% ( 18 ) of LE-related Abs. LGI1 is mainly a non-malignant tumor ( 9 – 11 ) and thought to be responsive to immunotherapy.…”

Section: Discussionmentioning

confidence: 99%

“…Cognitive impairment is the most common manifestation. Memory disorders, especially near memory disorders, are the most prominent ( 9 – 11 , 19 ). Some researchers ( 19 , 20 ) have confirmed that cognitive impairment was related to the course of disease before immunotherapy.…”

Section: Discussionmentioning

confidence: 99%

“…Anti-LGI1 encephalitis is the main type of autoimmune LE, generally ( 7 ) associated with rapidly progressing cognitive impairment. The main symptoms ( 8 – 11 ) were episodic memory impairment, temporal lobe seizures, asymmetric FBDS, and mental behavior abnormalities. As the most common type of VGKC-Ab encephalitis, cognitive disorders are common in anti-LGI1 encephalitis.…”

Section: Discussionmentioning

confidence: 99%

“…The better understanding will be of great significance for early diagnosis, essentially immunotherapy, and even better prognosis. Some studies suggest ( 9 – 11 , 23 ) that effective and long-term immunotherapy should be given to prevent long-term complications, including hippocampal atrophy ( 23 ) and sustained memory impairment ( 13 ). Second-line drugs can be added to the therapy of patients ( 23 , 24 ) who did not respond well to the first-line drugs or had a recurrence, including rituximab, MMF, or cyclophosphamide.…”

Section: Discussionmentioning

confidence: 99%

“…Cognitive impairment could be seen in most patients with anti-LGI1 encephalitis, and it is often ( 10 ), predominately, memory deterioration. It is reported ( 9 – 11 ) that about 25% of patients have complete recovery of cognitive function, whereas in others, mild disability may be a persistent sequela of the disease. There are more and more reports of patients with anti-LGI1 encephalitis ( 7 – 11 ); however, the characteristics of cognitive impairment in patients among the Chinese population with anti-LGI1 encephalitis have not been described.…”

Section: Introductionmentioning

confidence: 99%

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Clinical Characteristics of Cognitive Impairment and 1-Year Outcome in Patients With Anti-LGI1 Antibody Encephalitis

et al. 2020

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Introduction: Anti-leucine-rich glioma-inactivated 1 antibody (anti-LGI1) encephalitis is one of the most common autoimmune encephalitis. Anti-LGI1 encephalitis presented with subacute or acute onset of cognitive impairment, psychiatric disturbances, faciobrachial dystonic seizures (FBDSs), convulsions, and hyponatremia. The common sequela of anti-LGI1 encephalitis is cognitive disorder, but there are few studies on the recovery of cognitive function after immunotherapy. This study aimed to explore clinical characteristics of cognitive impairment and 1-year outcome in patients with anti-LGI1 encephalitis. Methods: The clinical data and characteristics of cognitive impairment of 21 patients with anti-LGI1 encephalitis from 2016 to 2019 in Nanjing Brain Hospital were analyzed retrospectively. At the time of onset of hospitalization and 1 year after discharge, the cognitive functions in these patients were assessed using two cognitive screening scales—Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment-Basic (MoCA-B). Results: Among the 21 patients, 13 were male and 8 were female, aged 51.10 ± 14.69 (age range 20–72) years. Nineteen patients, comprising 90.48%, had recent memory deterioration. Routine electroencephalography (EEG) results of 13 cases were abnormal. EEG results were epileptic or slow-wave activity involving the temporal lobes. Eleven cases of brain MRI were abnormal, and the focus involved the hippocampus and mediotemporal lobe. The decrease of short-term memory [recall scores: 0.57 ± 0.81 (MMSE), 0.76 ± 1.34 (MoCA-B)] is the most obvious at the time of admission. After intravenous (IV) injection of methylprednisolone and/or immunoglobulin, the clinical symptoms of the patients improved obviously. Total MMSE and MoCA-B scores of patients were significant increased after 1 year (21.19 ± 3.54 vs. 26.10 ± 3.02, P < 0.001; and 19.00 ± 4.38 vs. 25.19 ± 4.25, P < 0.001, respectively). Recall scores and orientation scores of MoCA-B were significantly improved after 1 year (0.76 ± 1.34 vs. 3.24 ± 1.48, P < 0.001; and 3.10 ± 1.26 vs. 5.00 ± 1.22, P < 0.001, respectively). However, 3/21 (14.29%) patients still have obvious short-term memory impairment (recall scores ≤ 1). Conclusion: Cognitive impairment is one of the most common manifestations of anti-LGI1 encephalitis, with the main prominent being acute or subacute short-term memory loss. Although most patients with anti-LGI1 encephalitis respond well to immunotherapy, a small number of patients still have cognitive disorders, mainly recent memory impairment, after 1 year.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Clinical Characteristics of Cognitive Impairment and 1-Year Outcome in Patients With Anti-LGI1 Antibody Encephalitis

et al. 2020

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Efficacy of immunotherapy and prognosis in anti‐LGI1 encephalitis patients: A meta‐analysis

Kong

Gong

et al. 2023

Ann Clin Transl Neurol

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ObjectiveTo assess the efficacy and safety of immunotherapy for LGI1 antibody encephalitis, and consider the predictors of poor outcomes following immunotherapy.MethodsWe searched PubMed and Embase for articles reporting the immunotherapy data of anti‐LGI1 encephalitis patients. The proportions of patients with poor outcomes (modified Rankin Scale [mRS] score > 2) at 3 months, 12 months, and the last follow‐up, as well as the odds ratio [OR] of predictors were pooled.ResultsThe review included 162 articles with 1066 patients. The proportion of patients with poor functional outcomes was 21% at 3 months, 14% at 12 months, and 14% at the last follow‐up after receiving immunotherapy. The proportion of patients with reported relapse was 16.6%. The mean duration from onset to the first relapse was 15.6 months. Predictors significantly associated with poor outcomes were age (increase of 1 year), the presence of cognitive impairment, and CSF LGI1 antibody positive. We did not find a statistically significant association between the worst mRS score in the acute phase, the presence of faciobrachial dystonic seizures (FBDS), days from symptom onset to immunotherapy, second‐line treatment, maintenance immunotherapy, or follow‐up time and outcomes.InterpretationAlthough most patients respond to immunotherapy, a minority of patients still have poor outcomes. Advanced age, cognitive impairment, and CSF LGI1 antibody positive are associated with an increased risk of poor outcomes. However, due to the insufficiency of the data, these conclusions need to be interpreted with caution.

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Determinants of cognition in autoimmune limbic encephalitis—A retrospective cohort study

et al. 2021

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Autoimmune limbic encephalitis (ALE) is the most common type of autoimmune encephalitis (AIE). Subacute memory disturbance, temporal lobe seizures, and psychiatric symptoms are clinical hallmarks of the disease. However, little is known on the factors contributing to cognitive functioning in ALE. Hence, we here investigate major determinants of cognitive functioning in ALE. In a retrospective analysis of 102 patients with ALE, we first compared verbal learning capacity, nonverbal learning capacity, and attentional and executive functioning by absence or presence of different types of neural autoantibodies (AABs). Subsequently we established three linear regression models including 63, 38, and 61 patients, respectively to investigate how cognitive functioning in these domains may depend on common markers of ALE such as intrathecal inflammation, blood‐cerebrospinal fluid (CSF)‐barrier function, mesiotemporal epileptiform discharges and slowing, determined by electroencephalography (EEG) and structural mesiotemporal changes, measured with magnetic resonance imaging (MRI). We also accounted for possible effects of cancer‐ and immunotherapy and other centrally effective medication. There was no effect of AAB status on cognitive functioning. Although the regression models could not predict verbal and nonverbal learning capacity, structural mesiotemporal neural network alterations on T2‐/fluid attenuated inversion recovery (FLAIR)‐signal‐weighted MRI and mesiotemporal epileptiform discharges or slowing on EEG exerted a significant impact on memory functions. In contrast, the regression model significantly predicted attentional and executive functioning with CSF white blood cell count and centrally effective medication being significant determinants. In this cohort, cognitive functioning in ALE does not depend on the AAB status. Common markers of ALE cannot predict memory functioning that only partially depends on structural and functional alterations of mesiotemporal neural networks. Common markers of ALE significantly predict attentional and executive functioning that is significantly related to centrally effective medication and CSF white blood cell count, which may point toward inflammation affecting brain regions beyond the limbic system.

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Telemedicine assessment of long-term cognitive and functional status in anti-leucine-rich, glioma-inactivated 1 encephalitis

Cited by 33 publications

References 32 publications

Clinical Characteristics of Cognitive Impairment and 1-Year Outcome in Patients With Anti-LGI1 Antibody Encephalitis

Clinical Characteristics of Cognitive Impairment and 1-Year Outcome in Patients With Anti-LGI1 Antibody Encephalitis

Efficacy of immunotherapy and prognosis in anti‐LGI1 encephalitis patients: A meta‐analysis

Determinants of cognition in autoimmune limbic encephalitis—A retrospective cohort study

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