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Basal ganglia T1 hyperintensity in LGI1-autoantibody faciobrachial dystonic seizures

OBJECTIVE: To characterize the clinical features and MRI abnormalities of leucine-rich glioma-inactivated 1 (LGI1)-autoantibody (Ab) faciobrachial dystonic seizures (FBDS). METHODS: Forty-eight patients with LGI1-Ab encephalopathy were retrospectively identified by searching our clinical and serolog...

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Autores principales: Flanagan, Eoin P., Kotsenas, Amy L., Britton, Jeffrey W., McKeon, Andrew, Watson, Robert E., Klein, Christopher J., Boeve, Bradley F., Lowe, Val, Ahlskog, J. Eric, Shin, Cheolsu, Boes, Christopher J., Crum, Brian A., Laughlin, Ruple S., Pittock, Sean J.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Lippincott Williams & Wilkins 2015
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4592539/
https://www.ncbi.nlm.nih.gov/pubmed/26468474
http://dx.doi.org/10.1212/NXI.0000000000000161
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author Flanagan, Eoin P.
Kotsenas, Amy L.
Britton, Jeffrey W.
McKeon, Andrew
Watson, Robert E.
Klein, Christopher J.
Boeve, Bradley F.
Lowe, Val
Ahlskog, J. Eric
Shin, Cheolsu
Boes, Christopher J.
Crum, Brian A.
Laughlin, Ruple S.
Pittock, Sean J.
author_facet Flanagan, Eoin P.
Kotsenas, Amy L.
Britton, Jeffrey W.
McKeon, Andrew
Watson, Robert E.
Klein, Christopher J.
Boeve, Bradley F.
Lowe, Val
Ahlskog, J. Eric
Shin, Cheolsu
Boes, Christopher J.
Crum, Brian A.
Laughlin, Ruple S.
Pittock, Sean J.
author_sort Flanagan, Eoin P.
collection PubMed
description OBJECTIVE: To characterize the clinical features and MRI abnormalities of leucine-rich glioma-inactivated 1 (LGI1)-autoantibody (Ab) faciobrachial dystonic seizures (FBDS). METHODS: Forty-eight patients with LGI1-Ab encephalopathy were retrospectively identified by searching our clinical and serologic database from January 1, 2002, to June 1, 2015. Of these, 26 met inclusion criteria for this case series: LGI1-Ab seropositivity and FBDS. In a separate analysis of all 48 patients initially identified, the MRIs of patients with (n = 26) and without (n = 22) FBDS were compared by 2 neuroradiologists blinded to the clinical details. RESULTS: The median age of the 26 included patients was 62.5 years (range 37–78); 65% were men. FBDS involved arm (26), face (22), and leg (12). Ten were previously diagnosed as psychogenic. Ictal EEGs were normal in 20 of 23 assessed. Basal ganglia T1 and T2 signal abnormalities were detected in 11 patients (42%), with excellent agreement between neuroradiologists (κ scores of 0.86 and 0.93, respectively), and included T1 hyperintensity alone (2), T2 hyperintensity alone (1), or both (8). The T1 hyperintensities persisted longer than the T2 hyperintensities (median 11 weeks vs 1 week, p = 0.02). Improvement with immunotherapy (18/18) was more frequent than with antiepileptic medications (10/24). A separate analysis of all 48 patients initially identified with LGI1-Ab encephalopathy showed that basal ganglia MRI abnormalities were present in 11 of 26 with FBDS but not present in those without FBDS (0/22) (p < 0.001). In contrast, mesial temporal MRI abnormalities were less common among those with FBDS (42%) than those without (91%) (p < 0.001). CONCLUSIONS: Basal ganglia T1 hyperintensity is a clinically useful MRI biomarker of LGI1-Ab FBDS and suggests a basal ganglia localization.
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spelling pubmed-45925392015-10-14 Basal ganglia T1 hyperintensity in LGI1-autoantibody faciobrachial dystonic seizures Flanagan, Eoin P. Kotsenas, Amy L. Britton, Jeffrey W. McKeon, Andrew Watson, Robert E. Klein, Christopher J. Boeve, Bradley F. Lowe, Val Ahlskog, J. Eric Shin, Cheolsu Boes, Christopher J. Crum, Brian A. Laughlin, Ruple S. Pittock, Sean J. Neurol Neuroimmunol Neuroinflamm Article OBJECTIVE: To characterize the clinical features and MRI abnormalities of leucine-rich glioma-inactivated 1 (LGI1)-autoantibody (Ab) faciobrachial dystonic seizures (FBDS). METHODS: Forty-eight patients with LGI1-Ab encephalopathy were retrospectively identified by searching our clinical and serologic database from January 1, 2002, to June 1, 2015. Of these, 26 met inclusion criteria for this case series: LGI1-Ab seropositivity and FBDS. In a separate analysis of all 48 patients initially identified, the MRIs of patients with (n = 26) and without (n = 22) FBDS were compared by 2 neuroradiologists blinded to the clinical details. RESULTS: The median age of the 26 included patients was 62.5 years (range 37–78); 65% were men. FBDS involved arm (26), face (22), and leg (12). Ten were previously diagnosed as psychogenic. Ictal EEGs were normal in 20 of 23 assessed. Basal ganglia T1 and T2 signal abnormalities were detected in 11 patients (42%), with excellent agreement between neuroradiologists (κ scores of 0.86 and 0.93, respectively), and included T1 hyperintensity alone (2), T2 hyperintensity alone (1), or both (8). The T1 hyperintensities persisted longer than the T2 hyperintensities (median 11 weeks vs 1 week, p = 0.02). Improvement with immunotherapy (18/18) was more frequent than with antiepileptic medications (10/24). A separate analysis of all 48 patients initially identified with LGI1-Ab encephalopathy showed that basal ganglia MRI abnormalities were present in 11 of 26 with FBDS but not present in those without FBDS (0/22) (p < 0.001). In contrast, mesial temporal MRI abnormalities were less common among those with FBDS (42%) than those without (91%) (p < 0.001). CONCLUSIONS: Basal ganglia T1 hyperintensity is a clinically useful MRI biomarker of LGI1-Ab FBDS and suggests a basal ganglia localization. Lippincott Williams & Wilkins 2015-10-01 /pmc/articles/PMC4592539/ /pubmed/26468474 http://dx.doi.org/10.1212/NXI.0000000000000161 Text en © 2015 American Academy of Neurology This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives License 4.0 (CC BY-NC-ND) (http://creativecommons.org/licenses/by-nc-nd/4.0/) , which permits downloading and sharing the work provided it is properly cited. The work cannot be changed in any way or used commercially.
spellingShingle Article
Flanagan, Eoin P.
Kotsenas, Amy L.
Britton, Jeffrey W.
McKeon, Andrew
Watson, Robert E.
Klein, Christopher J.
Boeve, Bradley F.
Lowe, Val
Ahlskog, J. Eric
Shin, Cheolsu
Boes, Christopher J.
Crum, Brian A.
Laughlin, Ruple S.
Pittock, Sean J.
Basal ganglia T1 hyperintensity in LGI1-autoantibody faciobrachial dystonic seizures
title Basal ganglia T1 hyperintensity in LGI1-autoantibody faciobrachial dystonic seizures
title_full Basal ganglia T1 hyperintensity in LGI1-autoantibody faciobrachial dystonic seizures
title_fullStr Basal ganglia T1 hyperintensity in LGI1-autoantibody faciobrachial dystonic seizures
title_full_unstemmed Basal ganglia T1 hyperintensity in LGI1-autoantibody faciobrachial dystonic seizures
title_short Basal ganglia T1 hyperintensity in LGI1-autoantibody faciobrachial dystonic seizures
title_sort basal ganglia t1 hyperintensity in lgi1-autoantibody faciobrachial dystonic seizures
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4592539/
https://www.ncbi.nlm.nih.gov/pubmed/26468474
http://dx.doi.org/10.1212/NXI.0000000000000161
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