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Limbic Encephalitis
"Palliating
delirium in patients with
cancer"
Limbic
Encephalitis Tied to Adult Onset
Epilepsy
Limbic encephalitis presenting
as delirium in a patient who
underwent bone-marrow transplant
for non-Hodgkin lymphomaCoronal
MRI shows high signal (white)
bilaterally in the temporal
lobes in the areas corresponding
to the hypocampal uncus. The
surrounding white matter shows
oedema (arrows). The CSF
examination confirmed diagnosis
of herpes 6 virus encephalitis.
By David Douglas
NEW YORK (Reuters Health) Oct
10 - Limbic encephalitis may
often be a precipitating event
in adult-onset temporal lobe
epilepsy, according to German
researchers.
Limbic encephalitis, lead
investigator Dr. Christian G.
Bien told Reuters Health, "is
protracted brain inflammation,
probably of autoimmune origin,
which is sometimes a corollary
of malignant diseases outside
the nervous system, but may also
occur without apparent cause."
In the September 18th issue
of Neurology, Dr. Bien of the
University of Bonn and
colleagues note that temporal
lobe epilepsy with hippocampal
sclerosis usually starts in
childhood or adolescence, but
can manifest in adulthood. "In
earlier times," added Dr. Bien,
"it could only be detected by
postmortem autopsies. Since the
early 1990s, hippocampal
sclerosis can be visualized by
brain MRI in vivo."
To characterize factors
associated with adult-onset
disease, the researchers
conducted a retrospective review
of data on 38 patients with
epilepsy onset at a median age
of 37.8 years.
Eleven had hippocampal
sclerosis due to events such as
head trauma and febrile
seizures, and seven were
classified as being of
idiopathic origin.
Nine had MRI findings typical
of limbic encephalitis, and
another eleven were deemed as
possibly having the condition.
Thus, say the investigators,
about half of the patients
showed evidence consistent with
an autoimmune process.
Subjects in these two
subgroups were significantly
more likely to have bilateral
abnormalities than were those
without such findings.
In an accompanying editorial,
Dr. Andrew G. Cole of
Massachusetts General Hospital
notes that the study has a
number of limitations, but
concludes that these results
"will trigger more aggressive
searches for immunomarkers in
patients with focal epilepsy of
unknown cause, whatever their
age."
Neurology
2007;69:1236-1244.
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