Electroencephalographic findings in antileucine-rich glioma-inactivated 1 (LGI1) autoimmune encephalitis: A systematic review

Background: Antileucine-rich glioma-inactivated 1 (LGI1) autoimmune encephalitis is a distinct syndrome of early onset faciobrachial dystonic seizures (FBDS) and other focal seizures followed by neuropsychiatric symptoms. The electroclinical syndrome of this condition is yet to be fully understood. The main objective of this study was to determine the frequencies of electroencephalogram (EEG) findings in patients diagnosed with anti-LGI1 autoimmune encephalitis through a systematic review of published relevant articles.

Methods: Major electronic healthcare databases were searched for relevant published articles until July 2020.

Results: From 327 articles, 23 case reports and 14 case series were included in the review after satisfying the eligibility criteria. Data from a total of 151 cases of definite anti-LGI1 encephalitis were analyzed in this systematic review. Epileptiform discharges were the most frequent finding at 57.3%. Focal electroencephalographic abnormalities including slow wave (59.3%) and epileptiform activities (53.5%) most commonly arise from the temporal region. Faciobrachial dystonic seizures often have no ictal electroencephalographic correlate but would show electrodecremental events when seizure duration is prolonged.

Conclusion: Electroencephalogram abnormalities are seen in anti-LGI1 autoimmune encephalitis with epileptiform discharges as the most common finding followed by focal slowing. These findings were most frequently seen arising in the temporal region. Further studies using a standardized protocol focusing on electroencephalographic findings in anti-LGI1 encephalitis with clinical correlation to disease stage and treatment outcomes in terms of seizure control and memory and cognitive function are needed. Particular attention on ictal electrodecremental activity during FBDS should be done in studies with a larger sample size.