A rare case of autoimmune limbic encephalitis: an uncharted territory!

Autoimmune encephalitis is rare. Several auto- antibodies are described in autoimmune encephalitis. We describe a case of autoimmune limbic encephalitis associated with positive voltage gated potassium channel (VGKC) antibodies and positive leucine-rich glioma inactivated protein 1 antibodies (LGI1). A 33-year-old Saudi housewife, she presented with 2 months history of cognitive deterioration and recurrent left facio-brachial dystonic seizures followed by generalized tonic clonic seizures. At times the seizures are preceded by rising epigastric aura and shortness of breath. The neurological examination was normal apart from upgoing left plantar reflex. She had borderline IQ of 76 with impaired verbal fluency and impaired visual and verbal memory. Magnetic resonance imaging of the brain showed right mesial temporal non-enhancing lesion. Cerebrospinal fluid examination was positive for LGI1 and VGKC. Optimal seizure control was achieved with immunotherapy.

Non-convulsive status epilepticus presenting with Wernicke's aphasia.

Ictal aphasia in adults is a rare phenomenon. Most reported cases manifest with non-fluent (Broca) aphasia. Ictal fluent (Wernicke) aphasia is less common. We report a 47-year-old, right-handed woman that presented with recurrent episodes of non-convulsive seizures in the form of Wernicke's aphasia for 2 weeks. An MRI of the brain showed an old cerebral infarction in the left parieto-occipital area. Scalp EEG revealed continuous periodic sharp waves at the left temporal regions with diffusion to the whole left hemisphere and at occasions to the right. This is followed by variable periods of post ictal slowing. Recurrence of the described ictal pattern was noted. Management of status epilepticus was started in the form of intravenous diazepam and a loading dose of phenytoin and phenobarbitone. After treatment, she improved clinically and the EEG improved with disappearance of the left temporal ictal rhythm and normalization of the EEG background. Thus, establishing the diagnosis of non-convulsive partial status epilepticus manifesting as ictal aphasia.

Women, epilepsy and anti-epileptic drugs.

Epilepsy is a chronic disease interlinked with many aspects of a womans life. The objective for this syllabus is to review these aspects and update physicians treating epileptic women on the recent management recommendations in this population. Epilepsy is more common in males except in adolescence and the elderly. Certain epileptic syndromes are exclusively seen in females such as Rett syndrome, Aicardi syndrome and periventricular nodular heterotopia. Female sex hormones may alter seizure threshold in epileptic women and form the basis for catamenial epilepsy. Seizures particularly those of temporal lobe may influence the normal hormonal balance leading to menstrual irregularities and probable reduced fertility. Although most pregnant epileptic women have successful outcomes of their pregnancies, there is an increased risk of maternal and fetal complications during pregnancy and labor in comparison to non-epileptic women. Menopausal epileptic women receiving anti-epileptic drugs that interfere with calcium and vitamin metabolism are at a higher risk for osteoporosis.