title: Focal paraneoplastic limbic encephalitis presenting as orgasmic epilepsy.
abstract: OBJECTIVE
  To report orgasmic epilepsy as a manifestation of paraneoplastic limbic encephalitis in a patient with small cell lung cancer.
  
  
  METHODS
  A 57 years-old woman presented with 2 month history of daily spells that consisted of a sudden pleasure provoking feeling described 'like an orgasm' lasting for 30 s to 1 min. She was a heavy smoker and had noted recent weight loss. Bronchial biopsy, following the finding of a right lung mass, confirmed the diagnosis of small cell lung cancer (SCLC). Spells subsided after starting carbamazepine. The lung cancer was treated with chemotherapy and chest radiation therapy resulting in a complete radiologic response.
  
  
  RESULTS
  Brain magnetic resonance imaging (MRI) revealed left temporal lobe area of increased signal on T2 and FLAIR sequence. T1-weighted images after contrast administration demonstrated a circumscribed area of enhancement in the left anterior medial temporal lobe. Electroencephalogram (EEG) showed focal left mid-temporal sharp waves and intermittent slowing. Anti-Hu antibodies were detected in her serum supporting a diagnosis of paraneoplastic limbic encephalitis as the cause of her orgasmic epilepsy. The patient has been followed for 2 years after treatment without tumor recurrence or neurological deterioration.
  
  
  CONCLUSIONS
  Orgasmic epilepsy is another mode of presentation of paraneoplastic limbic encephalitis leading to the diagnosis of an occult SCLC. EEG and MRI findings suggest that in this case the seizures originated from the left hemisphere. It is possible that early recognition and treatment of the SCLC will improve the prognosis of this neurologic entity.
authors.affiliation: Department of Medicine Sections of Hematology/Oncology and Neurology, Dartmouth Hitchcock Medical Center, Norris Cotton Cancer Center, One Medical Center Drive, Lebanon, NH 03756-0001, USA. camilo.e.fadul@hitchcock.org
authors.forename: C E
authors.initials: CE
authors.lastname: Fadul
authors.forename: E W
authors.initials: EW
authors.lastname: Stommel
authors.forename: K H
authors.initials: KH
authors.lastname: Dragnev
authors.forename: C J
authors.initials: CJ
authors.lastname: Eskey
authors.forename: J O
authors.initials: JO
authors.lastname: Dalmau
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D018288:Carcinoma, Small Cell / Q000150:complications* / Q000473:pathology / Q000628:therapy; D004833:Epilepsy, Temporal Lobe / Q000209:etiology* / Q000473:pathology / Q000523:psychology; D005260:Female; D006801:Humans; D020363:Limbic Encephalitis / Q000175:diagnosis / Q000209:etiology*; D008175:Lung Neoplasms / Q000150:complications* / Q000473:pathology / Q000628:therapy; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D009948:Orgasm; D020361:Paraneoplastic Syndromes, Nervous System / Q000175:diagnosis / Q000209:etiology*; D016896:Treatment Outcome