title: Progressive limbic encephalopathy: Problems and prospects.
abstract: BACKGROUND
  It was observed that a good number of patients presenting with psychiatric manifestations when investigated later because of unresponsiveness to treatment or late development of organic features turned out to be treatable limbic syndromes.
  
  
  BACKGROUND
  The aim of this study is to assess the patients presenting with new onset neuropsychiatric symptoms satisfying the criteria for probable limbic encephalitis.
  
  
  METHODS
  Patients referred to neurology department following a period of treatment for neuropsychiatric symptoms, which did not respond to conventional treatment were analyzed using Electroencephalography (EEG), magnetic resonance imaging, cerebrospinal fluid, screening for malignancy Vasculitic work-up, histopathology and autoantibody done when feasible.
  
  
  RESULTS
  There were 22 patients satisfying criteria for probable limbic encephalitis. Their mean age was 34.5 years. Symptoms varied from unexplained anxiety, panic and depression, lack of inhibition, wandering, incontinence, myoclonus, seizures and stroke like episodes. Three had systemic malignancy, 10 had chronic infection, one each with vasculitis, acute disseminated encephalomyelitis, Hashimoto encephalitis and two each with non-convulsive status, cryptogenic and Idiopathic inflammation.
  
  
  CONCLUSIONS
  All patients who present with new onset neuropsychiatric symptoms need to be evaluated for sub-acute infections, inflammation, autoimmune limbic encephalitis and paraneoplastic syndrome. A repeated 20 minute EEG is a very effective screening tool to detect organicity.
authors.affiliation: Department of Neurology, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India.
authors.forename: Sadanandavalli Retnaswami
authors.initials: SR
authors.lastname: Chandra
authors.affiliation: Department of Neuroradiology, Department of Radiology, Sri Ramachandra Institute of Medical Science and Technology, Chennai, Tamil Nadu, India.
authors.forename: Roopa
authors.initials: R
authors.lastname: Seshadri
authors.affiliation: Department of Neuropathology, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India.
authors.forename: Yasha
authors.initials: Y
authors.lastname: Chikabasaviah
authors.affiliation: Department of Clinical Neurosciences, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India.
authors.forename: Thomas Gregor
authors.initials: TG
authors.lastname: Issac
keywords: Chronic infection; limbic encephalitis; neuropsychology; paraneoplastic limbic encephalitis