Long-term Outcome of LGI-1 Encephalitis in Chinese: a 2-year follow-up

Long-term Outcome of LGI-1 Encephalitis in Chinese: a 2-year follow-up | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research article Long-term Outcome of LGI-1 Encephalitis in Chinese: a 2-year follow-up Wendeng Xu, Feifei He, Jian Wu, Jing Ye This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.2.10604/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Antibodies directed to leucien-rich glioma-inactivated 1 (LGI-1) encephalitis is a rare autoimmune encephalitis,characterized by limbic encephalitis syndrome and faciobrachial dystonic seizures (FBDS) . Most of cases are sensitive to immunotherapy in acute phase. Our aim was to give a detailed description of the long-term outcome of the LGI-1 encephalitis in Chinese . Methods We enrolled 36 patients with LGI-1 antibodies in serum/CSF from September 2013 to December 2016 and of which 28 patients were performed a 2-year follow-up. Clinical data of all patients was recorded and clinical outcome was assessed at 2-year follow-up. Follow-up MRI was scanned in partial patients. Results 11(39.3%)patients(mRS =0)had complete recovery,7(25.0%)patients(mRS =1)had mild neurological dysfunction, 10(7.2%)patients had severe neurological dysfunction(mRS≥2)and 8 patients (28.6%) had relapses.The numbers of patients with residual psychiatric change and memory deficit was 5 (17.8%)and 15(53.6%) respectively. No patients had a residual seizures and FBDS. Follow-up MRI were available in 10 patients. Among 5 patients with normal MRI in acute phase, 1 patients showed bilateral hippocampus atrophy on follow-up MRI and among 5 patients with abnormal MRI in acute phase, 4 patients showed lesion partial remission, 1 patients showed lesion dissolve on follow-up MRI. Conclusion Our study showed that only one third of patients with IGI-1 encephalitis got complete recovery at 2-year follow-up and relapses are common. The major residual symptom is memory deficit. Health Economics & Outcomes Research Neurology Immunology encephalitis IGI-1 follow-up long-term outcome Background LGI-1 encephalitis is a rare neurological disorder with sub-acute course of progressive encephalopathy and FBDS [1, 2] and which is the autoantigen associated with limbic encephalitis previously attributed to voltagegated potassium channels [3] . In addition to clinical manifestation of classic limbic encephalitis, some patients may develop hyponatremia and have preceding or concomitant myoclonic-like jerks described as FBDS [4, 5] . With the recognition of LGI-1 encephalitis, more and more cases were diagnosed as LGI-1 encephalitis and its incidence is rising. In our center, the frequency of LGI-1 encephalitis surpass other etiology of encephalitis in older, and the annual incidence in the Netherlands was 0.83/million [6] . Although, the investigation of clinical phenotype and antibody screening about LGI-1encephlitis have been well studied and this disease is sensitive to immunotherapy in acute phase, the long-term outcome of the disease still should be paid more attention, especially in neurological outcome and brain structure. Hence, we report cases series in Chinese focusing on the long-term clinical outcome. Methods Subjects We enrolled 36 patients diagnosed as LGI-1 encephalitis in Xuanwu Hospital, Capital Medical University, Beijing, China, from September 2013 to December 2016, according to the diagnosis criteria recommended by Graus [7] . Clinical information The clinical data was obtained in an interview with patients and relatives during hospital and from medical record and were recorded by an experienced neurologist (F.H, with more than 5 years of experience in neurology). According to the reported clinical features in previous publications [1, 3, 6, 8] , clinical phenotype were classified four main group: memory deficient , seizure, psychiatric change and FBDS. All patients performed MRI scan in acute phase and partial at follow-up. the following sequences including axial T2-weighted images, axial T1-weighted images, coronal T1-weighted images and fluid-attenuated inversion recovery images were obtained and the detailed protocol of MRI was seen in previous publication [9] . Clinical Outcome Measurement Among 36 patients enrolled in this study, 28 patients completed the 2-year follow-up by visiting to clinic or telephone. We used the modified Rankin Scale [10] to define the clinical outcome according to an neurologist (W.X with 3 years of experience in neurology) and, meanwhile assess the resident clinical phenotype according to an experienced neurologist (J.Y with more than 20 years of experience in neurology). We defined clinical relapse as the new onset or worsening of symptoms occurring after at least 2 months of improvement or stabilization similar to the definition of anti-N-methyl-D-aspartate receptor encephalitis [11] . Standard Protocol Approvals, Registrations, and Patient Consents The institutional review board of Xuanwu Hospital approved the study, and written informed consent was obtained from each participant before participation. statistical analysis In comparing 2 independent group clinical data，categorical data were analyzed with χ 2 text, numerical data with independent sample T test, with p values＜ 0.05 considered significant. SPSS 19 was used for analysis. Results Basic data of 36 patients in acute phase In this study, we enrolled 36 patients diagnosed as LGI-1 encephalitis. Clinical features of all patients in acute phase were summarized in table 1. Table (1) patients characteristics in acute phase Neurological outcome follow-up Long-term follow-up ≥2 years were available in 28 patients diagnosed as LGI-1 encephalitis. Average follow-up was 26.2±11.3months. 11(39.3%) patients（mRS =0）had a complete recovery. 15(53.6%) patients (mRS =1) have a mild neurological dysfunction with no limitation of work, 8(28.6%)patients have a mild neurological dysfunction with limitation of daily life, but can be independent , 2(7.2%)patients (mRS =3,4) have a moderate-severe neurological dysfunction, cannot be independent without help . Clinical phenotype follow-up Outcome of clinical phenotype were assessed in all 28 patients. Among 20 patients of LGI-1 encephalitis with psychiatric change in acute phase，5 (26.3%) patients remained mild psychiatric change at follow up, of which 3 patients showed character changed and 2 cases irritability. Among 26 patients of LGI-1 encephalitis with cognitive dysfunction in acute phase，15(57.7%) patients remain cognitive dysfunction at follow-up . No patients showed FBDS, seizures and hyponatremia at follow-up. Relapses 8 (28.6%) patients of LGI-1 encephalitis had a relapse. Median time from onset of initial disease episode to relapse was 7.4 months（2-26 months). Among 8 patients with relapse, of whom 3 patients only showed psychiatric change, 3 patients showed seizures and memory deficiency, 2 showed FBDS. All 8 patients with relapses were treated with immunotherapy at initial onset stage (IV corticosteroid =3, IV immunoglobin =1, IV corticosteroid and immunoglobin=4). A total of 8 patients with relapses were sensitive to immunotherapy (IV methylprednisolone =3, IV immunoglobin =5), 2 of whom were additionally treated with long-term immunotherapy (oral mycophenolate mofetil). Clinical characteristics related to clinical outcome Although the recognition of LGI-1 encephalitis is advancing along with more and more cases reported from worldwide, predictor factors related to outcome of LGI-1 encephalitis are still not clear. Therefore, we further investigated the relation of clinical characteristics to outcome. We defined mRS ≤1 at follow-up as favorable outcome group and mRS ≥2 as poor outcome group. clinical data of favorable outcome group and poor outcome group was compared in table2. Table2.clinical data comparing between favorable outcome group and poor outcome group. MRI follow-up Follow-up MRIs were available in 10 patients. Median time from symptom onset to follow-up MRI was 12 months (range 8–33 months). 4 patients with hippocampus lesion on initial MRI, of which 1 patient had hippocampus atrophy, 3 patients showed lesion partial remission on follow-up MRI. 1 patient with right striatum lesion on initial MRI showed normal MRI at follow-up. 5 patients with normal MRI, of which 4 patients still showed normal MRI, 1 patient showed bilateral hippocampus atrophy on follow-up MRI. Discussion In this study, we reported 28 patients diagnosed as LGI-1 encephalitis with a 2-year follow-up. More insights in the neurological function, outcome of clinical phenotype and MRI which is essential to recognize the disease prognosis. Only about one third of LGI-1 encephalitis patients got complete recovery and relapses were common. The major residual neurological disorder is memory deficiency. Although most of patients with LGI-1 encephalitis have a sensitive response to immunotherapy, only about one third of patients got a complete recovery and one third patient cannot back to work in our cohort. Meanwhile, the major residual neurological dysfunction is cognitive impairment consistent with prior publication [6, 12, 13] . In our study, 2 patients with severe neurological dysfunction at follow-up all resulting from residual dementia. Moreover, several case series have been reported LGI-1encephalitis can progress with slowly cognitive impairment [14-16] . Hence, the severity of long-term outcome of LGI-1 encephalitis may depend on the involvement of cognitive function. Clinical relapse occurred frequently in LGI-1 encephalitis. A total of 8 (28.6%) patients occurred clinical relapses in this cohort. Relapse rate were reported in earlier case series [6, 12] in (27-35%) similar to our results. Moreover, the longest duration from initial episodic to relapses is 8 years [6] . Therefore, the clinical relapse rate of this disease still may be underestimate and it should be paid more attention at follow-up. Predictor factors of LGI-1 encephalitis outcome investigated in prior study and responses to initial first-line immunotherapy and clinical relapse are predictors of poor outcome [12] . In our study, one has a poor outcome (mRS=4, at follow-up) with no response to initial first-line immunotherapy, but 8 patients with clinical relapse all can recover to the baseline function before relapse after immunotherapy. By comparing clinical data of two groups, we also find neither difference in immunotherapy treatment nor delay time of given immunotherapy treatment which is paradoxical with prior study [6, 12, 13] . The difference may stem from variability of cases enrolled in different study. The findings in a prospect study enrolled patients diagnosed as FBDS suggested immunotherapy is associated with favorable prognosis and may prevent the subsequent development of cognitive impairment [2] . Moreover, one study about natural course of LGI-1 encephalitis suggested LGI1 encephalitis had a monophonic course and spontaneously improved [17] . In a word, immunotherapy may be more effective to LGI-1patients only presented with FBDS. The MRI follow-up of LGI-1 encephalitis have been reported in various cohort and their major findings are the frequent of developing medial temporal sclerosis(MTS) and abnormal MRI resolved [6, 18] . In 10 patients with follow-up MRI in our cohort, only 2 patients developed medial temporal sclerosis. The reason may result from the time of follow-up MRI is too short. Moreover, one case with normal MRI in initial episodic showed MTS at follow-up MRI. It may indict that the LGI-1encephalitis with normal MRI may developed MTS. Moreover, we also performed an MRI follow-up to a patient with striatum lesion and the striatum lesion disappeared along with the recovery of clinical syndrome. The striatum involvement in duration of LGI-1 encephalitis have been reported in some case series and case reports [14, 19, 20] and the lesion frequently related to FBDS. As the cessation of FBDS in early time is important to prevent the development of cognitive impairment [21] , it is essential to recognize the striatum lesion which may be a diagnostic clue of LGI-1 encephalitis. Conclusion These long-term follow-up support that although the LGI-1 encephalitis has a sensitive response to immunotherapy in acute phase, only one third of patients can got a complete recovery, relapses were common and the major residual symptom was cognitive dysfunction. So, the further study should pay more attention to prevent the development of cognitive impairment during disease’s processing. Abbreviations LGI1: Leucien-rich glioma-inactivated 1; FBDS: Faciobrachial dystonic seizures; mRS: modified Ranking Scale; MRI: Magnetic Resonance Imaging; CSF: Cerebrospinal Fluid; MTS: Medial temporal lobe sclerosis. Declarations Ethics approval and consent to participate The institutional review board of Xuanwu Hospital approved the study, and written informed consent was obtained from each participant before participation. Consent for publication Not applicable. Availability of data and material All data generated or analyzed during this study are included in this published article. Competing interests The authors declare that they have no competing interests. Funding Not applicable. Authors' contributions Wendeng Xu, Jing Ye and Jian Wu participated in study design data collection. Feifei He performed statistical analysis. All authors read and approved the final manuscript. Acknowledgements The authors thanks to Mingyu li doctor for the contributions of the statistical analysis and collection of clinical data in this manuscript. The authors also acknowledge the contributions of Tian Zhang for collection of MRI data. References [1] Irani SR, Michell AW, Lang B, et al. Faciobrachial dystonic seizures precede Lgi1 antibody limbic encephalitis. Ann Neurol. 2011. 69(5): 892-900. [2] Irani SR, Stagg CJ, Schott JM, et al. Faciobrachial dystonic seizures: the influence of immunotherapy on seizure control and prevention of cognitive impairment in a broadening phenotype. Brain. 2013. 136(Pt 10): 3151-62. [3] Lai M, Huijbers MG, Lancaster E, et al. Investigation of LGI1 as the antigen in limbic encephalitis previously attributed to potassium channels: a case series. Lancet Neurol. 2010. 9(8): 776-85. [4] Duncan M, Cholfin J, Restrepo L. Clinical reasoning: a 72-year-old man with rapid cognitive decline and unilateral muscle jerks. Neurology. 2014. 82(22): e194-7. [5] Irani SR, Schott JM, Vincent A, Smith SJ. Tonic seizures: a diagnostic clue of anti-LGI1 encephalitis. Neurology. 2011. 77(24): 2140-1; author reply 2141-3. [6] van Sonderen A, Thijs RD, Coenders EC, et al. Anti-LGI1 encephalitis: Clinical syndrome and long-term follow-up. Neurology. 2016. 87(14): 1449-1456. [7]Graus F, Titulaer MJ, Balu R, et al. A clinical approach to diagnosis of autoimmune encephalitis. Lancet Neurol. 2016. 15(4): 391-404. [8] Sen A, Wang J, Laue-Gizzi H, Lee T, Ghougassian D, Somerville ER. Pathognomonic seizures in limbic encephalitis associated with anti-LGI1 antibodies. Lancet. 2014. 383(9933): 2018. [9] Zhang T, Duan Y, Ye J, et al. Brain MRI Characteristics of Patients with Anti-N-Methyl-D-Aspartate Receptor Encephalitis and Their Associations with 2-Year Clinical Outcome. AJNR Am J Neuroradiol. 2018. 39(5): 824-829. [10] van Swieten JC, Koudstaal PJ, Visser MC, Schouten HJ, van Gijn J. Interobserver agreement for the assessment of handicap in stroke patients. Stroke. 1988. 19(5): 604-7. [11]Titulaer MJ, McCracken L, Gabilondo I, et al. Treatment and prognostic factors for long-term outcome in patients with anti-NMDA receptor encephalitis: an observational cohort study. Lancet Neurol. 2013. 12(2): 157-65. [12]Ariño H, Armangué T, Petit-Pedrol M, et al. Anti-LGI1-associated cognitive impairment: Presentation and long-term outcome. Neurology. 2016. 87(8): 759-65. [13]Malter MP, Frisch C, Schoene-Bake JC, et al. Outcome of limbic encephalitis with VGKC-complex antibodies: relation to antigenic specificity. J Neurol. 2014. 261(9): 1695-705. [14] Sato M, Kishida D, Miyazaki D, Sekijima Y. A Patient with Limbic Encephalitis Associated with Anti-leucine-rich Glioma-inactivated 1 (LGI1) Antibody Presenting with Slowly Progressive Cognitive Impairment and Fluctuating Striatal Lesions. Intern Med. 2019. 58(2): 287-291. [15]Marquetand J, van Lessen M, Bender B, et al. Slowly progressive LGI1 encephalitis with isolated late-onset cognitive dysfunction: a treatable mimic of Alzheimer's disease. Eur J Neurol. 2016. 23(5): e28-9. [16] Molloy A, Cassidy E, Ryan A, O' TO. VGKC positive autoimmune encephalopathy mimicking dementia. BMJ Case Rep. 2011. 2011. [17]Szots M, Marton A, Kover F, et al. Natural course of LGI1 encephalitis: 3-5 years of follow-up without immunotherapy. J Neurol Sci. 2014. 343(1-2): 198-202. [18]Kotsenas AL, Watson RE, Pittock SJ, et al. MRI findings in autoimmune voltage-gated potassium channel complex encephalitis with seizures: one potential etiology for mesial temporal sclerosis. AJNR Am J Neuroradiol. 2014. 35(1): 84-9. [19] Flanagan EP, Kotsenas AL, Britton JW, et al. Basal ganglia T1 hyperintensity in LGI1-autoantibody faciobrachial dystonic seizures. Neurol Neuroimmunol Neuroinflamm. 2015. 2(6): e161. [20]Plantone D, Renna R, Grossi D, Plantone F, Iorio R. Teaching NeuroImages: Basal ganglia involvement in facio-brachial dystonic seizures associated with LGI1 antibodies. Neurology. 2013. 80(17): e183-4. [21] Thompson J, Bi M, Murchison AG, et al. The importance of early immunotherapy in patients with faciobrachial dystonic seizures. Brain. 2018. 141(2): 348-356. Tables Table (1) patients characteristics in acute phase Characteristics Values Male, n (%) 24(66.7) Age at onset, y, mean (range) 55.4(27-79) Psychiatric change n (%) 26(72.2) memory deficient n (%) 34(94.7) Seizures n (%) 27 （ 75 ） FBDS n (%) 20 （ 55.6 ） hyponatremia n (%) 20 (55.6) MRI at presentation n (%) Unilateral hippocampus lesion n (% 6(17.7) Bilateral hippocampus lesion n (%) Striatum lesion n (%)) 10(27.8) 4(11.1) LGI-1 assay Serum n (%) CSF n (%) 36(100) 32(88.9) Treatment No immunotherapy (%) Corticosteroid (%) Immunoglobin (%) Corticosteroid +immunoglobin (%) 3(8.3) 20(55.6) 8(22.2) 5(13.8) Table2.clinical data comparing between favorable outcome group and poor outcome group. Favorable outcome N=18 Poor outcome N=10 P value Age mean ± SD ,y, 51 ± 14 59 ± 12 0.153 Male (%) 10(55.6) 7(70.0) 0.689 FBDS (% ) 11(61.1) 7(70.0) 0.703 Psychiatric (%) 11(61.1) 9(90.0) 0.194 memory deficiency (%) 17(94.4) 9(90.0) 1.000 Seizures (%) 14(77.8) 7(70.0) 0.674 Hyponatremia (%) 10(55.6) 7(70.0) 0.689 Medial temporal lesion in MRI (%) 8(44.4) 5(50.0) 1.000 Treatment Corticosteroid/IVIg Corticosteroid+IVIg 15(83.3) 3(16.7) 8(80) 2(20) 1.000 Delay to treatment, mean ± SD , day 43 ± 18 61 ± 45 1.000 Relapse (%) 5(27.8) 3(30.0) 1.000 Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-1567","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research article","associatedPublications":[],"authors":[{"id":100575,"identity":"6a37d5e4-d6f3-4934-8270-dae77c2a6576","order_by":1,"name":"Wendeng Xu","email":"","orcid":"https://orcid.org/0000-0001-9733-1719","institution":"School of clinical medicine Tsinghua university","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Wendeng","middleName":"","lastName":"Xu","suffix":""},{"id":100576,"identity":"0b95095a-cdc6-4395-bfbe-14016d2c9855","order_by":2,"name":"Feifei He","email":"","orcid":"","institution":"Beijing geriatric hospital","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Feifei","middleName":"","lastName":"He","suffix":""},{"id":100577,"identity":"5f25355e-59ca-45a0-9f75-0e53d00406e9","order_by":3,"name":"Jian Wu","email":"","orcid":"","institution":"Tsinghua University","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Jian","middleName":"","lastName":"Wu","suffix":""},{"id":100578,"identity":"a69125a9-3df3-4c31-acb7-2029112ffea7","order_by":4,"name":"Jing Ye","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA2ElEQVRIiWNgGAWjYBACNv7GhgMfDGzk+Jn5Hz5IqKghrIVP4nDjwRkFacaS7TzMBg/OHCOsRY4hvfkwz4dDiQbnedgkH7YwE+EwhoMNB2cYHEgwOMx7rCKxgY2Bv707Ab8WZrBf7uRJHuZLu5G4Q4ZB4szZDcTY8qyY7zCD2Y3EM2wMBhK5hLQkNhzmMTgMJBnMChLbmEnQMuEwjxkDcVokwA4DBnIzW7JEwpljPAT9It/f/vjDhz/AqOQ/fPDjj4oaOf72XvxaMAAPacpHwSgYBaNgFGAFAAj+Uj+DCJTQAAAAAElFTkSuQmCC","orcid":"https://orcid.org/0000-0003-3507-5355","institution":"","correspondingAuthor":true,"submittingAuthor":false,"prefix":"","firstName":"Jing","middleName":"","lastName":"Ye","suffix":""}],"badges":[],"createdAt":"2019-06-21 15:13:09","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.2.10604/v1","doiUrl":"https://doi.org/10.21203/rs.2.10604/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":13467843,"identity":"1b2c3880-97ab-4fd9-aeb5-87807e32b1b5","added_by":"auto","created_at":"2021-09-16 20:56:34","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":423155,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-1567/v1/b78a5a6b-74a1-48d5-8cbe-624fcf551b79.pdf"}],"financialInterests":"","formattedTitle":"Long-term Outcome of LGI-1 Encephalitis in Chinese: a 2-year follow-up","fulltext":[{"header":"Background","content":" \n\u003cp\u003eLGI-1 encephalitis is a rare neurological disorder with sub-acute course of progressive\n encephalopathy and FBDS\u003csup\u003e[1, 2]\u003c/sup\u003e and which is the autoantigen associated with limbic encephalitis previously attributed\n to voltagegated potassium channels\u003csup\u003e[3]\u003c/sup\u003e. In addition to clinical manifestation of classic limbic encephalitis, some patients\n may develop hyponatremia and have preceding or concomitant myoclonic-like jerks described\n as FBDS\u003csup\u003e[4, 5]\u003c/sup\u003e. \u003c/p\u003e\n \n\u003cp\u003e With the recognition of LGI-1 encephalitis, more and more cases were diagnosed\n as LGI-1 encephalitis and its incidence is rising. In our center, the frequency of\n LGI-1 encephalitis surpass other etiology of encephalitis in older, and the annual\n incidence in the Netherlands was 0.83/million\u003csup\u003e[6]\u003c/sup\u003e. Although, the investigation of clinical phenotype and antibody screening about LGI-1encephlitis\n have been well studied and this disease is sensitive to immunotherapy in acute phase,\n the long-term outcome of the disease still should be paid more attention, especially\n in neurological outcome and brain structure. Hence, we report cases series in Chinese\n focusing on the long-term clinical outcome. \u003c/p\u003e"},{"header":"Methods","content":" \n\u003ch2\u003eSubjects\u003c/h2\u003e\n \n\u003cp\u003eWe enrolled 36 patients diagnosed as LGI-1 encephalitis in Xuanwu Hospital, Capital\n Medical University, Beijing, China, from September 2013 to December 2016, according\n to the diagnosis criteria recommended by Graus \u003csup\u003e[7]\u003c/sup\u003e .\u003c/p\u003e\n \n\u003ch2\u003eClinical information\u003c/h2\u003e\n \n\u003cp\u003eThe clinical data was obtained in an interview with patients and relatives during\n hospital and from medical record and were recorded by an experienced neurologist (F.H,\n with more than 5 years of experience in neurology). According to the reported clinical\n features in previous publications\u003csup\u003e[1, 3, 6, 8]\u003c/sup\u003e, clinical phenotype were classified four main group: memory deficient , seizure,\n psychiatric change and FBDS.\u003c/p\u003e\n \n\u003cp\u003eAll patients performed MRI scan in acute phase and partial at follow-up. the following\n sequences including axial T2-weighted images, axial T1-weighted images, coronal T1-weighted\n images and fluid-attenuated inversion recovery images were obtained and the detailed\n protocol of MRI was seen in previous publication\u003csup\u003e[9]\u003c/sup\u003e.\u003c/p\u003e\n \n\u003ch2\u003eClinical Outcome Measurement\u003c/h2\u003e\n \n\u003cp\u003eAmong 36 patients enrolled in this study, 28 patients completed the 2-year follow-up\n by visiting to clinic or telephone. We used the modified Rankin Scale \u003csup\u003e[10]\u003c/sup\u003eto define the clinical outcome according to an neurologist (W.X with 3 years of experience\n in neurology) and, meanwhile assess the resident clinical phenotype according to an experienced\n neurologist (J.Y with more than 20 years of experience in neurology). \u003c/p\u003e\n \n\u003cp\u003eWe defined clinical relapse as the new onset or worsening of symptoms occurring after\n at least 2 months of improvement or stabilization similar to the definition of anti-N-methyl-D-aspartate\n receptor encephalitis\u003csup\u003e[11]\u003c/sup\u003e. \u003c/p\u003e\n \n\u003cp\u003eStandard Protocol Approvals, Registrations, and Patient Consents\u003c/p\u003e\n \n\u003cp\u003eThe institutional review board of Xuanwu Hospital approved the study, and written\n informed consent was obtained from each participant before participation. \u003c/p\u003e\n \n\u003ch2\u003estatistical analysis\u003c/h2\u003e\n \n\u003cp\u003eIn comparing 2 independent group clinical data，categorical data were analyzed with χ\u003csup\u003e2\u003c/sup\u003e text, numerical data with independent sample T test, with p values＜ 0.05 considered\n significant. SPSS 19 was used for analysis.\u003c/p\u003e"},{"header":"Results","content":"\n\u003ch2\u003eBasic data of 36 patients in acute phase\u003c/h2\u003e\n \n\u003cp\u003eIn this study, we enrolled 36 patients diagnosed as LGI-1 encephalitis. Clinical features\n of all patients in acute phase were summarized in table 1.\u003c/p\u003e\n \n\u003cp\u003eTable (1) patients characteristics in acute phase\u003c/p\u003e\n\n\n\u003ch2\u003eNeurological outcome follow-up\u003c/h2\u003e\n \n\u003cp\u003eLong-term follow-up ≥2 years were available in 28 patients diagnosed as LGI-1 encephalitis.\n Average follow-up was 26.2±11.3months. 11(39.3%) patients（mRS =0）had a complete recovery.\n 15(53.6%) patients (mRS =1) have a mild neurological dysfunction with no limitation\n of work, 8(28.6%)patients have a mild neurological dysfunction with limitation of\n daily life, but can be independent , 2(7.2%)patients (mRS =3,4) have a moderate-severe\n neurological dysfunction, cannot be independent without help .\u003c/p\u003e\n \n\u003ch2\u003eClinical phenotype follow-up\u003c/h2\u003e\n \n\u003cp\u003eOutcome of clinical phenotype were assessed in all 28 patients. Among 20 patients\n of LGI-1 encephalitis with psychiatric change in acute phase，5 (26.3%) patients remained mild psychiatric change at follow up, of which 3 patients\n showed character changed and 2 cases irritability. Among 26 patients of LGI-1 encephalitis\n with cognitive dysfunction in acute phase，15(57.7%) patients remain cognitive dysfunction at follow-up . No patients showed\n FBDS, seizures and hyponatremia at follow-up.\u003c/p\u003e\n \n\u003ch2\u003eRelapses\u003c/h2\u003e\n \n\u003cp\u003e8 (28.6%) patients of LGI-1 encephalitis had a relapse. Median time from onset of\n initial disease episode to relapse was 7.4 months（2-26 months). Among 8 patients with\n relapse, of whom 3 patients only showed psychiatric change, 3 patients showed seizures\n and memory deficiency, 2 showed FBDS. All 8 patients with relapses were treated with\n immunotherapy at initial onset stage (IV corticosteroid =3, IV immunoglobin =1, IV\n corticosteroid and immunoglobin=4). A total of 8 patients with relapses were sensitive\n to immunotherapy (IV methylprednisolone =3, IV immunoglobin =5), 2 of whom were additionally\n treated with long-term immunotherapy (oral mycophenolate mofetil).\u003c/p\u003e\n \n\u003ch2\u003eClinical characteristics related to clinical outcome \u003c/h2\u003e\n \n\u003cp\u003eAlthough the recognition of LGI-1 encephalitis is advancing along with more and more\n cases reported from worldwide, predictor factors related to outcome of LGI-1 encephalitis\n are still not clear. Therefore, we further investigated the relation of clinical characteristics\n to outcome. We defined mRS ≤1 at follow-up as favorable outcome group and mRS ≥2 as\n poor outcome group. clinical data of favorable outcome group and poor outcome group\n was compared in table2. \u003c/p\u003e\n \n\u003cp\u003eTable2.clinical data comparing between favorable outcome group and poor outcome group.\n \u003c/p\u003e\n \n \n\n\u003ch2\u003eMRI follow-up\u003c/h2\u003e\n \n\u003cp\u003eFollow-up MRIs were available in 10 patients. Median time from symptom onset to follow-up\n MRI was 12 months (range 8–33 months). 4 patients with hippocampus lesion on initial\n MRI, of which 1 patient had hippocampus atrophy, 3 patients showed lesion partial\n remission on follow-up MRI. 1 patient with right striatum lesion on initial MRI showed\n normal MRI at follow-up. 5 patients with normal MRI, of which 4 patients still showed\n normal MRI, 1 patient showed bilateral hippocampus atrophy on follow-up MRI.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eIn this study, we reported 28 patients diagnosed as LGI-1 encephalitis with a 2-year\n follow-up. More insights in the neurological function, outcome of clinical phenotype\n and MRI which is essential to recognize the disease prognosis. Only about one third\n of LGI-1 encephalitis patients got complete recovery and relapses were common. The\n major residual neurological disorder is memory deficiency.\u003c/p\u003e\n \n\u003cp\u003e Although most of patients with LGI-1 encephalitis have a sensitive response to\n immunotherapy, only about one third of patients got a complete recovery and one third patient cannot\n back to work in our cohort. Meanwhile, the major residual neurological dysfunction\n is cognitive impairment consistent with prior publication\u003csup\u003e[6, 12, 13]\u003c/sup\u003e. In our study, 2 patients with severe neurological dysfunction at follow-up all resulting\n from residual dementia. Moreover, several case series have been reported LGI-1encephalitis\n can progress with slowly cognitive impairment\u003csup\u003e[14-16]\u003c/sup\u003e. Hence, the severity of long-term outcome of LGI-1 encephalitis may depend on the\n involvement of cognitive function. \u003c/p\u003e\n \n\u003cp\u003e Clinical relapse occurred frequently in LGI-1 encephalitis. A total of 8 (28.6%)\n patients occurred clinical relapses in this cohort. Relapse rate were reported in\n earlier case series\u003csup\u003e[6, 12]\u003c/sup\u003e in (27-35%) similar to our results. Moreover, the longest duration from initial episodic\n to relapses is 8 years\u003csup\u003e[6]\u003c/sup\u003e. Therefore, the clinical relapse rate of this disease still may be underestimate\n and it should be paid more attention at follow-up. \u003c/p\u003e\n \n\u003cp\u003e Predictor factors of LGI-1 encephalitis outcome investigated in prior study and\n responses to initial first-line immunotherapy and clinical relapse are predictors\n of poor outcome \u003csup\u003e[12]\u003c/sup\u003e. In our study, one has a poor outcome (mRS=4, at follow-up) with no response to initial\n first-line immunotherapy, but 8 patients with clinical relapse all can recover to\n the baseline function before relapse after immunotherapy. By comparing clinical data\n of two groups, we also find neither difference in immunotherapy treatment nor delay\n time of given immunotherapy treatment which is paradoxical with prior study\u003csup\u003e[6, 12, 13]\u003c/sup\u003e. The difference may stem from variability of cases enrolled in different study.\n The findings in a prospect study enrolled patients diagnosed as FBDS suggested immunotherapy\n is associated with favorable prognosis and may prevent the subsequent development\n of cognitive impairment \u003csup\u003e[2]\u003c/sup\u003e. Moreover, one study about natural course of LGI-1 encephalitis suggested LGI1 encephalitis\n had a monophonic course and spontaneously improved\u003csup\u003e[17]\u003c/sup\u003e. In a word, immunotherapy may be more effective to LGI-1patients only presented with\n FBDS.\u003c/p\u003e\n \n\u003cp\u003eThe MRI follow-up of LGI-1 encephalitis have been reported in various cohort and their\n major findings are the frequent of developing medial temporal sclerosis(MTS) and abnormal\n MRI resolved \u003csup\u003e[6, 18]\u003c/sup\u003e. In 10 patients with follow-up MRI in our cohort, only 2 patients developed medial\n temporal sclerosis. The reason may result from the time of follow-up MRI is too short.\n Moreover, one case with normal MRI in initial episodic showed MTS at follow-up MRI.\n It may indict that the LGI-1encephalitis with normal MRI may developed MTS. \u003c/p\u003e\n \n\u003cp\u003eMoreover, we also performed an MRI follow-up to a patient with striatum lesion and\n the striatum lesion disappeared along with the recovery of clinical syndrome. The\n striatum involvement in duration of LGI-1 encephalitis have been reported in some\n case series and case reports\u003csup\u003e[14, 19, 20]\u003c/sup\u003e and the lesion frequently related to FBDS. As the cessation of FBDS in early time\n is important to prevent the development of cognitive impairment\u003csup\u003e[21]\u003c/sup\u003e, it is essential to recognize the striatum lesion which may be a diagnostic clue\n of LGI-1 encephalitis.\u003c/p\u003e\n \n\u003ch2\u003eConclusion \u003c/h2\u003e\n \n\u003cp\u003eThese long-term follow-up support that although the LGI-1 encephalitis has a sensitive\n response to immunotherapy in acute phase, only one third of patients can got a complete\n recovery, relapses were common and the major residual symptom was cognitive dysfunction.\n So, the further study should pay more attention to prevent the development of cognitive\n impairment during disease’s processing. \u003c/p\u003e"},{"header":"Abbreviations","content":" \n\u003cp\u003eLGI1: Leucien-rich glioma-inactivated 1; FBDS: Faciobrachial dystonic seizures; mRS:\n modified Ranking Scale; MRI: Magnetic Resonance Imaging; CSF: Cerebrospinal Fluid;\n MTS: Medial temporal lobe sclerosis. \u003c/p\u003e"},{"header":"Declarations","content":" \u003cp\u003eEthics approval and consent to participate\u003c/p\u003e \n\u003cp\u003eThe institutional review board of Xuanwu Hospital approved the study, and written\n informed consent was obtained from each participant before participation.\u003c/p\u003e\u003cp\u003eConsent for publication\u003c/p\u003e\n \n\u003cp\u003eNot applicable.\u003c/p\u003e\u003cp\u003eAvailability of data and material\u003c/p\u003e\n \n\u003cp\u003eAll data generated or analyzed during this study are included in this published article.\u003c/p\u003e\u003cp\u003eCompeting interests\u003c/p\u003e\n \n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\u003cp\u003eFunding \u003c/p\u003e\n \n\u003cp\u003eNot applicable.\u003c/p\u003e\u003cp\u003eAuthors' contributions\u003c/p\u003e\n \n\u003cp\u003eWendeng Xu, Jing Ye and Jian Wu participated in study design data collection. Feifei\n He performed statistical analysis. All authors read and approved the final manuscript.\u003c/p\u003e\u003cp\u003eAcknowledgements\u003c/p\u003e\n \n\u003cp\u003e The authors thanks to Mingyu li doctor for the contributions of the statistical analysis\n and collection of clinical data in this manuscript. The authors also acknowledge the\n contributions of Tian Zhang for collection of MRI data. \u003c/p\u003e"},{"header":"References","content":" \n\u003cp\u003e[1]\n Irani SR, Michell AW, Lang B, et al. Faciobrachial dystonic seizures precede Lgi1\n antibody limbic encephalitis. Ann Neurol. 2011. 69(5): 892-900.\u003c/p\u003e\n \n\u003cp\u003e[2]\n Irani SR, Stagg CJ, Schott JM, et al. Faciobrachial dystonic seizures: the influence\n of immunotherapy on seizure control and prevention of cognitive impairment in a broadening\n phenotype. Brain. 2013. 136(Pt 10): 3151-62.\u003c/p\u003e\n \n\u003cp\u003e[3]\n Lai M, Huijbers MG, Lancaster E, et al. Investigation of LGI1 as the antigen in limbic\n encephalitis previously attributed to potassium channels: a case series. Lancet Neurol.\n 2010. 9(8): 776-85.\u003c/p\u003e\n \n\u003cp\u003e[4]\n Duncan M, Cholfin J, Restrepo L. Clinical reasoning: a 72-year-old man with rapid\n cognitive decline and unilateral muscle jerks. Neurology. 2014. 82(22): e194-7.\u003c/p\u003e\n \n\u003cp\u003e[5]\n Irani SR, Schott JM, Vincent A, Smith SJ. Tonic seizures: a diagnostic clue of anti-LGI1\n encephalitis. Neurology. 2011. 77(24): 2140-1; author reply 2141-3.\u003c/p\u003e\n \n\u003cp\u003e[6]\n van Sonderen A, Thijs RD, Coenders EC, et al. Anti-LGI1 encephalitis: Clinical syndrome\n and long-term follow-up. Neurology. 2016. 87(14): 1449-1456.\u003c/p\u003e\n \n\u003cp\u003e[7]Graus F, Titulaer MJ, Balu R, et al. A clinical approach to diagnosis of autoimmune\n encephalitis. Lancet Neurol. 2016. 15(4): 391-404.\u003c/p\u003e\n \n\u003cp\u003e[8]\n Sen A, Wang J, Laue-Gizzi H, Lee T, Ghougassian D, Somerville ER. Pathognomonic seizures\n in limbic encephalitis associated with anti-LGI1 antibodies. Lancet. 2014. 383(9933):\n 2018.\u003c/p\u003e\n \n\u003cp\u003e[9]\n Zhang T, Duan Y, Ye J, et al. Brain MRI Characteristics of Patients with Anti-N-Methyl-D-Aspartate\n Receptor Encephalitis and Their Associations with 2-Year Clinical Outcome. AJNR Am\n J Neuroradiol. 2018. 39(5): 824-829.\u003c/p\u003e\n \n\u003cp\u003e[10]\n van Swieten JC, Koudstaal PJ, Visser MC, Schouten HJ, van Gijn J. Interobserver agreement\n for the assessment of handicap in stroke patients. Stroke. 1988. 19(5): 604-7.\u003c/p\u003e\n \n\u003cp\u003e[11]Titulaer MJ, McCracken L, Gabilondo I, et al. Treatment and prognostic factors for\n long-term outcome in patients with anti-NMDA receptor encephalitis: an observational\n cohort study. Lancet Neurol. 2013. 12(2): 157-65.\u003c/p\u003e\n \n\u003cp\u003e[12]Ariño H, Armangué T, Petit-Pedrol M, et al. Anti-LGI1-associated cognitive impairment:\n Presentation and long-term outcome. Neurology. 2016. 87(8): 759-65.\u003c/p\u003e\n \n\u003cp\u003e[13]Malter MP, Frisch C, Schoene-Bake JC, et al. Outcome of limbic encephalitis with VGKC-complex\n antibodies: relation to antigenic specificity. J Neurol. 2014. 261(9): 1695-705.\u003c/p\u003e\n \n\u003cp\u003e[14]\n Sato M, Kishida D, Miyazaki D, Sekijima Y. A Patient with Limbic Encephalitis Associated\n with Anti-leucine-rich Glioma-inactivated 1 (LGI1) Antibody Presenting with Slowly\n Progressive Cognitive Impairment and Fluctuating Striatal Lesions. Intern Med. 2019.\n 58(2): 287-291.\u003c/p\u003e\n \n\u003cp\u003e[15]Marquetand J, van Lessen M, Bender B, et al. Slowly progressive LGI1 encephalitis\n with isolated late-onset cognitive dysfunction: a treatable mimic of Alzheimer's disease.\n Eur J Neurol. 2016. 23(5): e28-9.\u003c/p\u003e\n \n\u003cp\u003e[16]\n Molloy A, Cassidy E, Ryan A, O' TO. VGKC positive autoimmune encephalopathy mimicking\n dementia. BMJ Case Rep. 2011. 2011.\u003c/p\u003e\n \n\u003cp\u003e[17]Szots M, Marton A, Kover F, et al. Natural course of LGI1 encephalitis: 3-5 years\n of follow-up without immunotherapy. J Neurol Sci. 2014. 343(1-2): 198-202.\u003c/p\u003e\n \n\u003cp\u003e[18]Kotsenas AL, Watson RE, Pittock SJ, et al. MRI findings in autoimmune voltage-gated\n potassium channel complex encephalitis with seizures: one potential etiology for mesial\n temporal sclerosis. AJNR Am J Neuroradiol. 2014. 35(1): 84-9.\u003c/p\u003e\n \n\u003cp\u003e[19]\n Flanagan EP, Kotsenas AL, Britton JW, et al. Basal ganglia T1 hyperintensity in LGI1-autoantibody\n faciobrachial dystonic seizures. 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Brain. 2018. 141(2): 348-356.\u003c/p\u003e"},{"header":"Tables","content":"\u003cp style=\"text-align: left;\"\u003e\u003cstrong\u003e\u003cspan style=\"font-size: 12.0pt;\"\u003eTable (1) patients characteristics in acute phase\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003ctable style=\"border-collapse: collapse; border: none;\"\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd style=\"width: 213.05pt; border-top: solid black 1.0pt; border-left: none; border-bottom: solid black 1.0pt; border-right: none; padding: 0in 5.4pt 0in 5.4pt;\" width=\"284\"\u003e\n\u003cp style=\"text-align: left;\"\u003e\u003cstrong\u003e\u003cspan style=\"font-size: 12.0pt;\"\u003eCharacteristics \u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 213.05pt; border-top: solid black 1.0pt; border-left: none; border-bottom: solid black 1.0pt; border-right: none; padding: 0in 5.4pt 0in 5.4pt;\" width=\"284\"\u003e\n\u003cp style=\"text-align: left;\"\u003e\u003cstrong\u003e\u003cspan style=\"font-size: 12.0pt;\"\u003eValues\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd style=\"width: 213.05pt; border: none; padding: 0in 5.4pt 0in 5.4pt;\" width=\"284\"\u003e\n\u003cp style=\"text-align: left;\"\u003e\u003cstrong\u003e\u003cspan style=\"font-size: 12.0pt;\"\u003eMale, n (%)\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 213.05pt; border: none; padding: 0in 5.4pt 0in 5.4pt;\" width=\"284\"\u003e\n\u003cp style=\"text-align: left;\"\u003e\u003cspan style=\"font-size: 12.0pt;\"\u003e24(66.7)\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd style=\"width: 213.05pt; border: none; padding: 0in 5.4pt 0in 5.4pt;\" width=\"284\"\u003e\n\u003cp style=\"text-align: left;\"\u003e\u003cstrong\u003e\u003cspan style=\"font-size: 12.0pt;\"\u003eAge at onset, y, mean (range)\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 213.05pt; border: none; padding: 0in 5.4pt 0in 5.4pt;\" width=\"284\"\u003e\n\u003cp style=\"text-align: left;\"\u003e\u003cspan style=\"font-size: 12.0pt;\"\u003e55.4(27-79)\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd style=\"width: 213.05pt; border: none; padding: 0in 5.4pt 0in 5.4pt;\" width=\"284\"\u003e\n\u003cp style=\"text-align: left;\"\u003e\u003cstrong\u003e\u003cspan style=\"font-size: 12.0pt;\"\u003ePsychiatric change n (%)\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 213.05pt; border: none; padding: 0in 5.4pt 0in 5.4pt;\" width=\"284\"\u003e\n\u003cp style=\"text-align: left;\"\u003e\u003cspan style=\"font-size: 12.0pt;\"\u003e26(72.2)\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd style=\"width: 213.05pt; border: none; padding: 0in 5.4pt 0in 5.4pt;\" width=\"284\"\u003e\n\u003cp style=\"text-align: left;\"\u003e\u003cstrong\u003e\u003cspan style=\"font-size: 12.0pt;\"\u003ememory deficient n (%)\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 213.05pt; border: none; padding: 0in 5.4pt 0in 5.4pt;\" width=\"284\"\u003e\n\u003cp style=\"text-align: left;\"\u003e\u003cspan style=\"font-size: 12.0pt;\"\u003e34(94.7)\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd style=\"width: 213.05pt; border: none; padding: 0in 5.4pt 0in 5.4pt;\" width=\"284\"\u003e\n\u003cp style=\"text-align: left;\"\u003e\u003cstrong\u003e\u003cspan style=\"font-size: 12.0pt;\"\u003eSeizures n (%)\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 213.05pt; border: none; padding: 0in 5.4pt 0in 5.4pt;\" width=\"284\"\u003e\n\u003cp style=\"text-align: left;\"\u003e\u003cspan style=\"font-size: 12.0pt;\"\u003e27\u003c/span\u003e\u003cspan style=\"font-size: 12.0pt; font-family: SimSun;\"\u003e（\u003c/span\u003e\u003cspan style=\"font-size: 12.0pt;\"\u003e75\u003c/span\u003e\u003cspan style=\"font-size: 12.0pt; font-family: SimSun;\"\u003e）\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd style=\"width: 213.05pt; border: none; padding: 0in 5.4pt 0in 5.4pt;\" width=\"284\"\u003e\n\u003cp style=\"text-align: left;\"\u003e\u003cstrong\u003e\u003cspan style=\"font-size: 12.0pt;\"\u003eFBDS n (%)\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 213.05pt; border: none; padding: 0in 5.4pt 0in 5.4pt;\" width=\"284\"\u003e\n\u003cp style=\"text-align: left;\"\u003e\u003cspan style=\"font-size: 12.0pt;\"\u003e20\u003c/span\u003e\u003cspan style=\"font-size: 12.0pt; font-family: SimSun;\"\u003e（\u003c/span\u003e\u003cspan style=\"font-size: 12.0pt;\"\u003e55.6\u003c/span\u003e\u003cspan style=\"font-size: 12.0pt; font-family: SimSun;\"\u003e）\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd style=\"width: 213.05pt; border: none; padding: 0in 5.4pt 0in 5.4pt;\" width=\"284\"\u003e\n\u003cp style=\"text-align: left;\"\u003e\u003cstrong\u003e\u003cspan style=\"font-size: 12.0pt;\"\u003ehyponatremia n (%)\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 213.05pt; border: none; padding: 0in 5.4pt 0in 5.4pt;\" width=\"284\"\u003e\n\u003cp style=\"text-align: left;\"\u003e\u003cspan style=\"font-size: 12.0pt;\"\u003e20 (55.6)\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd style=\"width: 213.05pt; border: none; padding: 0in 5.4pt 0in 5.4pt;\" width=\"284\"\u003e\n\u003cp style=\"text-align: left;\"\u003e\u003cstrong\u003e\u003cspan style=\"font-size: 12.0pt;\"\u003eMRI at presentation n (%)\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp style=\"text-align: left;\"\u003e\u003cstrong\u003e\u003cspan style=\"font-size: 12.0pt;\"\u003e\u0026nbsp; Unilateral hippocampus lesion n (%\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp; \u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 213.05pt; border: none; padding: 0in 5.4pt 0in 5.4pt;\" width=\"284\"\u003e\n\u003cp style=\"text-align: left;\"\u003e\u003cspan style=\"font-size: 12.0pt;\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n\u003cp style=\"text-align: left;\"\u003e\u003cspan style=\"font-size: 12.0pt;\"\u003e6(17.7)\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd style=\"width: 213.05pt; border: none; padding: 0in 5.4pt 0in 5.4pt;\" width=\"284\"\u003e\n\u003cp style=\"text-align: left;\"\u003e\u003cstrong\u003e\u003cspan style=\"font-size: 12.0pt;\"\u003e\u0026nbsp; Bilateral hippocampus lesion n (%)\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp style=\"text-align: left;\"\u003e\u003cstrong\u003e\u003cspan style=\"font-size: 12.0pt;\"\u003e\u0026nbsp; Striatum lesion n (%))\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 213.05pt; border: none; padding: 0in 5.4pt 0in 5.4pt;\" width=\"284\"\u003e\n\u003cp style=\"text-align: left;\"\u003e\u003cspan style=\"font-size: 12.0pt;\"\u003e10(27.8)\u003c/span\u003e\u003c/p\u003e\n\u003cp style=\"text-align: left;\"\u003e\u003cspan style=\"font-size: 12.0pt;\"\u003e4(11.1)\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd style=\"width: 213.05pt; border: none; padding: 0in 5.4pt 0in 5.4pt;\" width=\"284\"\u003e\n\u003cp style=\"text-align: left;\"\u003e\u003cstrong\u003e\u003cspan style=\"font-size: 12.0pt;\"\u003eLGI-1 assay \u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp style=\"text-align: left;\"\u003e\u003cstrong\u003e\u003cspan style=\"font-size: 12.0pt;\"\u003e\u0026nbsp;\u0026nbsp; Serum n (%)\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp; \u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp style=\"text-align: left;\"\u003e\u003cstrong\u003e\u003cspan style=\"font-size: 12.0pt;\"\u003e\u0026nbsp;\u0026nbsp; CSF n (%)\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 213.05pt; border: none; padding: 0in 5.4pt 0in 5.4pt;\" width=\"284\"\u003e\n\u003cp style=\"text-align: left;\"\u003e\u003cspan style=\"font-size: 12.0pt;\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n\u003cp style=\"text-align: left;\"\u003e\u003cspan style=\"font-size: 12.0pt;\"\u003e36(100)\u003c/span\u003e\u003c/p\u003e\n\u003cp style=\"text-align: left;\"\u003e\u003cspan style=\"font-size: 12.0pt;\"\u003e32(88.9)\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd style=\"width: 213.05pt; border: none; border-bottom: solid black 1.0pt; padding: 0in 5.4pt 0in 5.4pt;\" width=\"284\"\u003e\n\u003cp style=\"text-align: left;\"\u003e\u003cstrong\u003e\u003cspan style=\"font-size: 12.0pt;\"\u003eTreatment\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp style=\"text-align: left;\"\u003e\u003cstrong\u003e\u003cspan style=\"font-size: 12.0pt;\"\u003e\u0026nbsp; No immunotherapy (%)\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp style=\"text-align: left;\"\u003e\u003cstrong\u003e\u003cspan style=\"font-size: 12.0pt;\"\u003e\u0026nbsp; Corticosteroid (%)\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp style=\"text-align: left;\"\u003e\u003cstrong\u003e\u003cspan style=\"font-size: 12.0pt;\"\u003e\u0026nbsp; Immunoglobin (%)\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp style=\"text-align: left;\"\u003e\u003cstrong\u003e\u003cspan style=\"font-size: 12.0pt;\"\u003e\u0026nbsp; Corticosteroid +immunoglobin (%)\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 213.05pt; border: none; border-bottom: solid black 1.0pt; padding: 0in 5.4pt 0in 5.4pt;\" width=\"284\"\u003e\n\u003cp style=\"text-align: left;\"\u003e\u003cspan style=\"font-size: 12.0pt;\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n\u003cp style=\"text-align: left;\"\u003e\u003cspan style=\"font-size: 12.0pt;\"\u003e3(8.3)\u003c/span\u003e\u003c/p\u003e\n\u003cp style=\"text-align: left;\"\u003e\u003cspan style=\"font-size: 12.0pt;\"\u003e20(55.6)\u003c/span\u003e\u003c/p\u003e\n\u003cp style=\"text-align: left;\"\u003e\u003cspan style=\"font-size: 12.0pt;\"\u003e8(22.2)\u003c/span\u003e\u003c/p\u003e\n\u003cp style=\"text-align: left;\"\u003e\u003cspan style=\"font-size: 12.0pt;\"\u003e5(13.8)\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp style=\"text-align: left;\"\u003e\u003cspan style=\"font-size: 12.0pt;\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cspan style=\"font-size: 12.0pt;\"\u003eTable2.clinical data comparing between favorable outcome group and poor outcome group.\u0026nbsp; \u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003ctable style=\"border-collapse: collapse; border: none;\"\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd style=\"width: 119.7pt; border-top: solid black 1.0pt; border-left: none; border-bottom: solid black 1.0pt; border-right: none; padding: 0in 5.4pt 0in 5.4pt;\" width=\"160\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cspan style=\"font-size: 12.0pt;\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 115.3pt; border-top: solid black 1.0pt; border-left: none; border-bottom: solid black 1.0pt; border-right: none; padding: 0in 5.4pt 0in 5.4pt;\" colspan=\"2\" width=\"154\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cspan style=\"font-size: 12.0pt;\"\u003eFavorable outcome\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cspan style=\"font-size: 12.0pt;\"\u003eN=18\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 90.75pt; border-top: solid black 1.0pt; border-left: none; border-bottom: solid black 1.0pt; border-right: none; padding: 0in 5.4pt 0in 5.4pt;\" width=\"121\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cspan style=\"font-size: 12.0pt;\"\u003ePoor outcome\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cspan style=\"font-size: 12.0pt;\"\u003eN=10\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 100.35pt; border-top: solid black 1.0pt; border-left: none; border-bottom: solid black 1.0pt; border-right: none; padding: 0in 5.4pt 0in 5.4pt;\" width=\"134\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cspan style=\"font-size: 12.0pt;\"\u003eP value\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd style=\"width: 119.7pt; border: none; padding: 0in 5.4pt 0in 5.4pt;\" width=\"160\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cspan style=\"font-size: 12.0pt;\"\u003eAge mean\u003c/span\u003e\u003c/strong\u003e\u003cstrong\u003e\u003cspan style=\"font-size: 12.0pt; font-family: SimSun;\"\u003e\u0026plusmn;\u003c/span\u003e\u003c/strong\u003e\u003cstrong\u003e\u003cspan style=\"font-size: 12.0pt;\"\u003eSD\u003c/span\u003e\u003c/strong\u003e\u003cstrong\u003e\u003cspan style=\"font-size: 12.0pt;\"\u003e,y, \u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 104.05pt; border: none; padding: 0in 5.4pt 0in 5.4pt;\" width=\"139\"\u003e\n\u003cp\u003e\u003cspan style=\"font-size: 12.0pt;\"\u003e51\u003c/span\u003e\u003cspan style=\"font-size: 12.0pt; font-family: SimSun;\"\u003e\u0026plusmn;\u003c/span\u003e\u003cspan style=\"font-size: 12.0pt;\"\u003e14\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 102.0pt; border: none; padding: 0in 5.4pt 0in 5.4pt;\" colspan=\"2\" width=\"136\"\u003e\n\u003cp\u003e\u003cspan style=\"font-size: 12.0pt;\"\u003e59\u003c/span\u003e\u003cspan style=\"font-size: 12.0pt; font-family: SimSun;\"\u003e\u0026plusmn;\u003c/span\u003e\u003cspan style=\"font-size: 12.0pt;\"\u003e12\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 100.35pt; border: none; padding: 0in 5.4pt 0in 5.4pt;\" width=\"134\"\u003e\n\u003cp\u003e\u003cspan style=\"font-size: 12.0pt;\"\u003e0.153\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd style=\"width: 119.7pt; border: none; padding: 0in 5.4pt 0in 5.4pt;\" width=\"160\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cspan style=\"font-size: 12.0pt;\"\u003eMale (%) \u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 104.05pt; border: none; padding: 0in 5.4pt 0in 5.4pt;\" width=\"139\"\u003e\n\u003cp\u003e\u003cspan style=\"font-size: 12.0pt;\"\u003e10(55.6)\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 102.0pt; border: none; padding: 0in 5.4pt 0in 5.4pt;\" colspan=\"2\" width=\"136\"\u003e\n\u003cp\u003e\u003cspan style=\"font-size: 12.0pt;\"\u003e7(70.0)\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 100.35pt; border: none; padding: 0in 5.4pt 0in 5.4pt;\" width=\"134\"\u003e\n\u003cp\u003e\u003cspan style=\"font-size: 12.0pt;\"\u003e0.689\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd style=\"width: 119.7pt; border: none; padding: 0in 5.4pt 0in 5.4pt;\" width=\"160\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cspan style=\"font-size: 12.0pt;\"\u003eFBDS \u003c/span\u003e\u003c/strong\u003e\u003cspan style=\"font-size: 12.0pt; color: windowtext;\"\u003e(%\u003c/span\u003e\u003cstrong\u003e\u003cspan style=\"font-size: 12.0pt;\"\u003e)\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 104.05pt; border: none; padding: 0in 5.4pt 0in 5.4pt;\" width=\"139\"\u003e\n\u003cp\u003e\u003cspan style=\"font-size: 12.0pt;\"\u003e11(61.1)\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 102.0pt; border: none; padding: 0in 5.4pt 0in 5.4pt;\" colspan=\"2\" width=\"136\"\u003e\n\u003cp\u003e\u003cspan style=\"font-size: 12.0pt;\"\u003e7(70.0)\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 100.35pt; border: none; padding: 0in 5.4pt 0in 5.4pt;\" width=\"134\"\u003e\n\u003cp\u003e\u003cspan style=\"font-size: 12.0pt;\"\u003e0.703\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd style=\"width: 119.7pt; border: none; padding: 0in 5.4pt 0in 5.4pt;\" width=\"160\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cspan style=\"font-size: 12.0pt;\"\u003ePsychiatric (%)\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 104.05pt; border: none; padding: 0in 5.4pt 0in 5.4pt;\" width=\"139\"\u003e\n\u003cp\u003e\u003cspan style=\"font-size: 12.0pt;\"\u003e11(61.1)\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 102.0pt; border: none; padding: 0in 5.4pt 0in 5.4pt;\" colspan=\"2\" width=\"136\"\u003e\n\u003cp\u003e\u003cspan style=\"font-size: 12.0pt;\"\u003e9(90.0)\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 100.35pt; border: none; padding: 0in 5.4pt 0in 5.4pt;\" width=\"134\"\u003e\n\u003cp\u003e\u003cspan style=\"font-size: 12.0pt;\"\u003e0.194\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd style=\"width: 119.7pt; border: none; padding: 0in 5.4pt 0in 5.4pt;\" width=\"160\"\u003e\n\u003cp style=\"margin-left: 12.05pt; text-indent: -12.05pt;\"\u003e\u003cstrong\u003e\u003cspan style=\"font-size: 12.0pt; color: windowtext;\"\u003ememory deficiency (%)\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 104.05pt; border: none; padding: 0in 5.4pt 0in 5.4pt;\" width=\"139\"\u003e\n\u003cp\u003e\u003cspan style=\"font-size: 12.0pt;\"\u003e17(94.4)\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 102.0pt; border: none; padding: 0in 5.4pt 0in 5.4pt;\" colspan=\"2\" width=\"136\"\u003e\n\u003cp\u003e\u003cspan style=\"font-size: 12.0pt;\"\u003e9(90.0)\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 100.35pt; border: none; padding: 0in 5.4pt 0in 5.4pt;\" width=\"134\"\u003e\n\u003cp\u003e\u003cspan style=\"font-size: 12.0pt;\"\u003e1.000\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd style=\"width: 119.7pt; border: none; padding: 0in 5.4pt 0in 5.4pt;\" width=\"160\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cspan style=\"font-size: 12.0pt; color: windowtext;\"\u003eSeizures (%)\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 104.05pt; border: none; padding: 0in 5.4pt 0in 5.4pt;\" width=\"139\"\u003e\n\u003cp\u003e\u003cspan style=\"font-size: 12.0pt;\"\u003e14(77.8)\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 102.0pt; border: none; padding: 0in 5.4pt 0in 5.4pt;\" colspan=\"2\" width=\"136\"\u003e\n\u003cp\u003e\u003cspan style=\"font-size: 12.0pt;\"\u003e7(70.0)\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 100.35pt; border: none; padding: 0in 5.4pt 0in 5.4pt;\" width=\"134\"\u003e\n\u003cp\u003e\u003cspan style=\"font-size: 12.0pt;\"\u003e0.674\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd style=\"width: 119.7pt; border: none; padding: 0in 5.4pt 0in 5.4pt;\" width=\"160\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cspan style=\"font-size: 12.0pt;\"\u003eHyponatremia (%)\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 104.05pt; border: none; padding: 0in 5.4pt 0in 5.4pt;\" width=\"139\"\u003e\n\u003cp\u003e\u003cspan style=\"font-size: 12.0pt;\"\u003e10(55.6)\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 102.0pt; border: none; padding: 0in 5.4pt 0in 5.4pt;\" colspan=\"2\" width=\"136\"\u003e\n\u003cp\u003e\u003cspan style=\"font-size: 12.0pt;\"\u003e7(70.0)\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 100.35pt; border: none; padding: 0in 5.4pt 0in 5.4pt;\" width=\"134\"\u003e\n\u003cp\u003e\u003cspan style=\"font-size: 12.0pt;\"\u003e0.689\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd style=\"width: 119.7pt; border: none; padding: 0in 5.4pt 0in 5.4pt;\" width=\"160\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cspan style=\"font-size: 12.0pt;\"\u003eMedial temporal lesion in MRI (%)\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 104.05pt; border: none; padding: 0in 5.4pt 0in 5.4pt;\" width=\"139\"\u003e\n\u003cp\u003e\u003cspan style=\"font-size: 12.0pt;\"\u003e8(44.4)\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 102.0pt; border: none; padding: 0in 5.4pt 0in 5.4pt;\" colspan=\"2\" width=\"136\"\u003e\n\u003cp\u003e\u003cspan style=\"font-size: 12.0pt;\"\u003e5(50.0)\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 100.35pt; border: none; padding: 0in 5.4pt 0in 5.4pt;\" width=\"134\"\u003e\n\u003cp\u003e\u003cspan style=\"font-size: 12.0pt;\"\u003e1.000\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd style=\"width: 119.7pt; border: none; padding: 0in 5.4pt 0in 5.4pt;\" width=\"160\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cspan style=\"font-size: 12.0pt;\"\u003eTreatment\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp style=\"margin-left: 11.8pt; text-indent: -5.8pt;\"\u003e\u003cstrong\u003e\u003cspan style=\"font-size: 12.0pt;\"\u003eCorticosteroid/IVIg\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp style=\"margin-left: 11.8pt; text-indent: -5.8pt;\"\u003e\u003cstrong\u003e\u003cspan style=\"font-size: 12.0pt;\"\u003eCorticosteroid+IVIg\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 104.05pt; border: none; padding: 0in 5.4pt 0in 5.4pt;\" width=\"139\"\u003e\n\u003cp\u003e\u003cspan style=\"font-size: 12.0pt;\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n\u003cp\u003e\u003cspan style=\"font-size: 12.0pt;\"\u003e15(83.3)\u003c/span\u003e\u003c/p\u003e\n\u003cp\u003e\u003cspan style=\"font-size: 12.0pt;\"\u003e3(16.7)\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 102.0pt; border: none; padding: 0in 5.4pt 0in 5.4pt;\" colspan=\"2\" width=\"136\"\u003e\n\u003cp\u003e\u003cspan style=\"font-size: 12.0pt;\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n\u003cp\u003e\u003cspan style=\"font-size: 12.0pt;\"\u003e8(80)\u003c/span\u003e\u003c/p\u003e\n\u003cp\u003e\u003cspan style=\"font-size: 12.0pt;\"\u003e2(20)\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 100.35pt; border: none; padding: 0in 5.4pt 0in 5.4pt;\" width=\"134\"\u003e\n\u003cp\u003e\u003cspan style=\"font-size: 12.0pt;\"\u003e1.000\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd style=\"width: 119.7pt; border: none; padding: 0in 5.4pt 0in 5.4pt;\" width=\"160\"\u003e\n\u003cp\u003e\u003cstrong\u003eDelay to treatment, mean\u003c/strong\u003e\u003cstrong\u003e\u003cspan style=\"font-size: 12.0pt; font-family: SimSun;\"\u003e\u0026plusmn;\u003c/span\u003e\u003c/strong\u003e\u003cstrong\u003e\u003cspan style=\"font-size: 12.0pt;\"\u003eSD\u003c/span\u003e, day\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 104.05pt; border: none; padding: 0in 5.4pt 0in 5.4pt;\" width=\"139\"\u003e\n\u003cp\u003e\u003cspan style=\"font-size: 12.0pt;\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n\u003cp\u003e\u003cspan style=\"font-size: 12.0pt;\"\u003e43\u003c/span\u003e\u003cspan style=\"font-size: 12.0pt; font-family: SimSun;\"\u003e\u0026plusmn;\u003c/span\u003e\u003cspan style=\"font-size: 12.0pt;\"\u003e18\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 102.0pt; border: none; padding: 0in 5.4pt 0in 5.4pt;\" colspan=\"2\" width=\"136\"\u003e\n\u003cp\u003e\u003cspan style=\"font-size: 12.0pt;\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n\u003cp\u003e\u003cspan style=\"font-size: 12.0pt;\"\u003e61\u003c/span\u003e\u003cspan style=\"font-size: 12.0pt; font-family: SimSun;\"\u003e\u0026plusmn;\u003c/span\u003e\u003cspan style=\"font-size: 12.0pt;\"\u003e45\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 100.35pt; border: none; padding: 0in 5.4pt 0in 5.4pt;\" width=\"134\"\u003e\n\u003cp\u003e\u003cspan style=\"font-size: 12.0pt;\"\u003e1.000\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd style=\"width: 119.7pt; border: none; border-bottom: solid black 1.0pt; padding: 0in 5.4pt 0in 5.4pt;\" width=\"160\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cspan style=\"font-size: 12.0pt;\"\u003eRelapse (%)\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 104.05pt; border: none; border-bottom: solid black 1.0pt; padding: 0in 5.4pt 0in 5.4pt;\" width=\"139\"\u003e\n\u003cp\u003e\u003cspan style=\"font-size: 12.0pt;\"\u003e5(27.8)\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 102.0pt; border: none; border-bottom: solid black 1.0pt; padding: 0in 5.4pt 0in 5.4pt;\" colspan=\"2\" width=\"136\"\u003e\n\u003cp\u003e\u003cspan style=\"font-size: 12.0pt;\"\u003e3(30.0)\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 100.35pt; border: none; border-bottom: solid black 1.0pt; padding: 0in 5.4pt 0in 5.4pt;\" width=\"134\"\u003e\n\u003cp\u003e\u003cspan style=\"font-size: 12.0pt;\"\u003e1.000\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd style=\"border: none;\" width=\"162\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd style=\"border: none;\" width=\"134\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd style=\"border: none;\" width=\"14\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd style=\"border: none;\" width=\"117\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd style=\"border: none;\" width=\"127\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cspan style=\"font-size: 12.0pt;\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"encephalitis, IGI-1, follow-up, long-term outcome ","lastPublishedDoi":"10.21203/rs.2.10604/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.2.10604/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"Background\n\nAntibodies directed to leucien-rich glioma-inactivated 1 (LGI-1) encephalitis is a rare autoimmune encephalitis,characterized by limbic encephalitis syndrome and faciobrachial dystonic seizures (FBDS) . Most of cases are sensitive to immunotherapy in acute phase. Our aim was to give a detailed description of the long-term outcome of the LGI-1 encephalitis in Chinese .\n\nMethods\n\nWe enrolled 36 patients with LGI-1 antibodies in serum/CSF from September 2013 to December 2016 and of which 28 patients were performed a 2-year follow-up. Clinical data of all patients was recorded and clinical outcome was assessed at 2-year follow-up. Follow-up MRI was scanned in partial patients.\n\nResults\n\n11(39.3%)patients(mRS =0)had complete recovery,7(25.0%)patients(mRS =1)had mild neurological dysfunction, 10(7.2%)patients had severe neurological dysfunction(mRS≥2)and 8 patients (28.6%) had relapses.The numbers of patients with residual psychiatric change and memory deficit was 5 (17.8%)and 15(53.6%) respectively. No patients had a residual seizures and FBDS. Follow-up MRI were available in 10 patients. Among 5 patients with normal MRI in acute phase, 1 patients showed bilateral hippocampus atrophy on follow-up MRI and among 5 patients with abnormal MRI in acute phase, 4 patients showed lesion partial remission, 1 patients showed lesion dissolve on follow-up MRI.\n\nConclusion\n\nOur study showed that only one third of patients with IGI-1 encephalitis got complete recovery at 2-year follow-up and relapses are common. The major residual symptom is memory deficit.","manuscriptTitle":"Long-term Outcome of LGI-1 Encephalitis in Chinese: a 2-year follow-up","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2019-06-25 02:23:45","doi":"10.21203/rs.2.10604/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"e5e9722b-cb5e-436e-b47c-fe8d82f9f62b","owner":[],"postedDate":"June 25th, 2019","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":14424,"name":"Health Economics \u0026 Outcomes Research"},{"id":14425,"name":"Neurology"},{"id":14426,"name":"Immunology"}],"tags":[],"updatedAt":"","versionOfRecord":[],"versionCreatedAt":"2019-06-25 02:23:45","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-1567","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"identity":"rs-1567","version":["v1"]},"buildId":"-HB7Z8yhvgn0wM9Nzuekk","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}