Department of Neurosciences, Santa Maria Hospital (CHLN, EPE), Institute of Molecular Medicine, Lisbon Faculty of Medicine, Laboratory of Neuropathology, Santa Maria Hospital (CHLN, EPE), Department of Neurosurgery, Santa Maria Hospital (CHLN, EPE), Laboratory of EEG/Sleep, Santa Maria Hospital (CHLN, EPE), Language Research Laboratory, Lisbon Faculty of Medicine, Neurological Imaging Department, Santa Maria Hospital (CHLN, EPE), Lisbon, Portugal
Limbic encephalitis with LGI1 antibodies may cause drug-resistant temporal lobe epilepsy. We report a case of a young man with progressive drug-resistant focal epilepsy, hyperhidrosis, and memory impairment associated with a left mesial temporal lesion. Epilepsy surgery was performed with the provisional diagnosis of cortical dysplasia or tumour. A neuropathological study following amygdalohippocampectomy revealed limbic encephalitis and LGI1 antibodies were identified in the serum. Two and a half years after surgery, the patient remains seizure-free without medication, with normal memory and without hyperhidrosis. Although immunosuppression is the first-line therapy for autoimmune limbic encephalitis, this case suggests that, in selected cases, a lasting response can be achieved with surgery.