Proposition: Limbic encephalitis may represent limbic status epilepticus. A review of clinical and EEG characteristics

Peter W. Kaplan, Andrea O. Rossetti, Emma H. Kaplan, Heinz Gregor Wieser

Research output: Contribution to journalReview articlepeer-review

Abstract

Limbic encephalitis (LE) with waxing and waning neuropsychiatric manifestations including behavioral, personality, psychiatric, and memory changes can evolve over days to months. Many features of LE show remarkable overlap with the characteristics of mesial-temporal (limbic) status epilepticus (MTLSE or LSE). With LE, these prolonged impaired states are assumed not to be due to ongoing epileptic activity or MTLSE, because scalp EEGs usually show no epileptiform spike-wave activity; cycling behavioral and motor changes are attributed to LE; there may be little immediate improvement with antiepileptic drugs (AEDs); and of course, implanted electrodes are rarely used. Conversely, it is known that in pre-surgical patients with refractory limbic epilepsy, implanted electrodes have revealed limbic seizures that cannot be seen at the scalp. This paper assembles a chain of inferences to advance the proposition that refractory LE might represent LSE more often than is thought, and that implanted electrodes should be considered in some cases. We present two cases that suggest that LE was also LSE, one of which warranted implanted electrodes (case 1).

Original languageEnglish (US)
Pages (from-to)1-6
Number of pages6
JournalEpilepsy and Behavior
Volume24
Issue number1
DOIs
StatePublished - May 2012

Keywords

  • Autoimmune
  • Limbic encephalitis
  • Limbic status epilepticus

ASJC Scopus subject areas

  • Neurology
  • Clinical Neurology
  • Behavioral Neuroscience

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