Long-term evolution and prognostic factors of epilepsy in limbic encephalitis with LGI1 antibodies
Résumé
Results: 39 patients with LGI1 encephalitis were included with a median follow-up duration of 42 months (range 13-169). All of them reported seizures at the acute phase, with faciobrachial dystonic seizures (FBDS) in 23 (59%) and other focal seizures in 38 (97%), including 4 patients (10%) with de novo status epilepticus. At the last follow-up visit, 11 patients (28%) achieved epilepsy remission. Among the 28 patients with persistent epilepsy, eight (29%) fulfilled criteria of DRE. The only factor significantly associated with epilepsy remission was the time from clinical onset of the encephalitis to initiation of the first immunomodulatory treatment, with longer delay in patients with persistent epilepsy (7.5±8.9 vs 2.4±1.7 months, p=0.006). Evolution to DRE was only driven by MRI evolution. Eight of the 15 patients (53 %) who developed hippocampal atrophy (p=0.007) also suffered from drug-resistant seizures at the last follow-up. Significance: In patients with LGI1 encephalitis, rapid initiation of immunomodulatory treatment favors longterm epilepsy remission. Evolution to DRE might primarily reflect the anatomical lesion of limbic structures. Determining what modalities of immune treatment may alter these outcomes requires prospective studies with long-term follow-up.
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