title: Proposition: limbic encephalitis may represent limbic status epilepticus. A review of clinical and EEG characteristics.
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).
authors.affiliation: The Johns Hopkins Bayview Medical Center, Department of Neurology, 4940 Eastern Avenue, Baltimore, MD 21224, USA. pkaplan@jhmi.edu
authors.forename: Peter W
authors.initials: PW
authors.lastname: Kaplan
authors.forename: Andrea O
authors.initials: AO
authors.lastname: Rossetti
authors.forename: Emma H
authors.initials: EH
authors.lastname: Kaplan
authors.forename: Heinz-Gregor
authors.initials: HG
authors.lastname: Wieser
mesh_terms: D000927:Anticonvulsants; D016206:Databases, Bibliographic / Q000706:statistics & numerical data; D004569:Electroencephalography; D005260:Female; D006801:Humans; D056747:Immunomodulation; D020363:Limbic Encephalitis / Q000150:complications* / Q000276:immunology; D008032:Limbic System / Q000503:physiopathology*; D008875:Middle Aged; D013226:Status Epilepticus / Q000209:etiology* / Q000473:pathology* / Q000628:therapy; D055815:Young Adult
chemical_list: D000927:Anticonvulsants