Limbic Encephalitis Associated with Anti-Voltage-Gated Potassium Channel Complex Antibodies as a Cause of Adult-Onset Mesial Temporal Lobe Epilepsy

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  • TOYOTA Tomoko
    Department of Neurology, School of Medicine, University of Occupational and Environmental Health, Japan
  • AKAMATSU Naoki
    Department of Neurology, School of Medicine, University of Occupational and Environmental Health, Japan
  • TSUJI Sadatoshi
    Department of Medical technology and science. International University of Health and Welfare, Japan.
  • NISHIZAWA Shigeru
    Department of Neurosurgery, School of Medicine,University of Occupational and Environmental Health, Japan.

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Other Title
  • 抗Voltage-Gated Potassium Channel複合体抗体関連辺縁系脳炎の関与が考えられた成人発症内側側頭葉てんかんの1例

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Abstract

Recently, some reports have indicated that limbic encephalitis associated with anti-voltage-gated potassium channel complex antibodies (VGKC-Ab) is a cause of adult-onset mesial temporal lobe epilepsy (MTLE). We report a 53-year-old woman who had her first epileptic seizure at the age of 50 years old. Examination by 3-Tesla brain MRI revealed left hippocampal high signal intensity and swelling on fluid-attenuated inversion recovery (FLAIR) and T2-weighted imaging at 2 months after her first seizure. The patient received intravenous methylprednisolone and carbamazepine 300 mg/day. One month later, MRI revealed improvement of her left hippocampal abnormalities. Thereafter, she had no seizures, however, three years after her first seizure, EEG revealed a seizure pattern in the left temporal region. Brain MRI revealed left hippocampal high signal intensity and brain fluorodeoxyglucose positron emission tomography revealed hypermetabolism. Her serum VGKC-Ab levels were 118 pM(normal < 100 pM). Intravenous methylprednisolone therapy was reinitiated. Two months later, her hippocampal abnormalities had improved and 3 months later her VGKC-Ab levels decreased to 4.4 pM. Remission of the epileptic seizures was also observed. This MTLE in the middle age was considered as limbic encephalitis associated with anti- VGKC-Ab. In cases of unexplained adult-onset MTLE, limbic encephalitis associated with anti-VGKC-Ab, which responds well to immunotherapy, should be considered in the differential diagnosis.

Journal

  • Journal of UOEH

    Journal of UOEH 36 (2), 129-133, 2014

    The University of Occupational and Environmental Health, Japan

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