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Course and outcome of acute limbic encephalitis with negative voltage-gated potassium channel antibodies
  1. S R Samarasekera1,
  2. A Vincent2,
  3. J L Welch3,
  4. M Jackson4,
  5. P Nichols5,
  6. T D Griffiths6
  1. 1Royal Victoria Infirmary, Newcastle upon Tyne, UK
  2. 2Department of Clinical Neurology, University of Oxford, Oxford, UK
  3. 3Department of Neuropsychology, Newcastle General Hospital, Newcastle upon Tyne, UK
  4. 4Department of Neurology, Newcastle General Hospital, Newcastle upon Tyne, UK
  5. 5Department of Neurology, Royal Victoria Infirmary, Newcastle upon Tyne, UK
  6. 6Newcastle University Medical School, Framlington Place, Newcastle upon Tyne, UK
  1. Correspondence to:
 Professor T D Griffiths
 Newcastle University Medical School, Framlington Place, Newcastle upon Tyne NE2 4HH, UK;t.d.griffiths{at}ncl.ac.uk

Abstract

Background: Limbic encephalitis is a potentially treatable immunological condition. The presence of voltage-gated potassium channel antibodies (VGKC-Ab) in the cerebrospinal fluid (CSF) and serum of patients with the condition is a marker of the disease associated with a non-paraneoplastic form and good response to treatment. Recent work has highlighted absent serum VGKC-Ab and distinct immunology in patients with the paraneoplastic form of limbic encephalitis.

Methods: The cases of four patients with the typical clinical presentation, neuropsychological features and brain imaging of acute limbic encephalitis, in the absence of any evidence for associated cancer during a follow-up of at least 18 months are described here.

Results: All patients had negative testing for VGKC-Ab measured during their acute presentation. All patients made some recovery, although they were left with marked cognitive deficits and persistent seizures.

Conclusion: These cases demonstrate that the absence of VGKC-Ab in limbic encephalitis does not necessarily imply a paraneoplastic form. Further work is required to establish the immunological basis for the disorder in these patients, and the optimal treatment regimen.

  • CPS, complex partial seizures
  • CSF, cerebrospinal fluid
  • VGKC-Ab, voltage-gated potassium channel antibodies

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Footnotes

  • Published Online First 10 November 2006

  • Competing interests: None.

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