High Grade Glioma Mimicking Voltage Gated Potassium Channel Complex Associated Antibody Limbic Encephalitis

Though raised titres of voltage gated potassium channel (VGKC) complex antibodies have been occasionally associated with extracranial tumours, mainly presenting as Morvan's Syndrome or neuromyotonia, they have not yet been reported to be associated with an intracranial malignancy. This is especially important as misdiagnosis of these conditions and delay of the appropriate treatment can have important prognostic implications. We describe a patient with a high grade glioma presenting with clinical, radiological, and serological features consistent with the diagnosis of VGKC antibody associated limbic encephalitis (LE). This is the first association between a primary brain tumour and high titre of VGKC complex antibodies. Clinicoradiological progression despite effective immunosuppressive treatment should prompt clinicians to look for alternative diagnoses. Further studies to elucidate a possible association between VGKC complex and other surface antigen antibodies with primary brain tumours should be carried out.

Download Full-text

Limbic encephalitis with voltage gated potassium channel antibodies in a child

Neuropediatrics ◽

10.1055/s-2008-1079504 ◽

2008 ◽

Vol 39 (01) ◽

Author(s):

E Haberlandt ◽

CG Bien ◽

A Reiter ◽

B Simma ◽

R Crazzolara ◽

...

Keyword(s):

Potassium Channel ◽

Limbic Encephalitis ◽

Voltage Gated

Download Full-text

Voltage-gated potassium channel limbic encephalitis presenting as functional cognitive impairment

BMJ Case Reports ◽

10.1136/bcr-2019-233179 ◽

2020 ◽

Vol 13 (12) ◽

pp. e233179

Author(s):

Eric Garrels ◽

Fawziya Huq ◽

Gavin McKay

Keyword(s):

Cognitive Impairment ◽

Case Report ◽

Potassium Channel ◽

Limbic Encephalitis ◽

Psychiatric Symptoms ◽

Differential Diagnoses ◽

Visual Hallucinations ◽

Voltage Gated ◽

History Of ◽

Impaired Cognition

Limbic encephalitis is often reported to present as seizures and impaired cognition with little focus on psychiatric presentations. In this case report, we present a 49-year-old man who initially presented to the Psychiatric Liaison Service with a several month history of confusion with the additional emergence of visual hallucinations and delusions. Due to the inconsistent nature of the symptoms in the context of a major financial stressor, a provisional functional cognitive impairment diagnosis was made. Investigations later revealed a positive titre of voltage-gated potassium channel (VGKC) antibodies, subtype leucine-rich glioma inactivated 1 accounting for his symptoms which dramatically resolved with steroids and immunoglobulins. This case highlighted the need for maintaining broad differential diagnoses in a patient presenting with unusual psychiatric symptoms.

Download Full-text

Reversible Dementia: Two Nursing Home Patients With Voltage-Gated Potassium Channel Antibody-Associated Limbic Encephalitis

Journal of the American Medical Directors Association ◽

10.1016/j.jamda.2015.06.008 ◽

2015 ◽

Vol 16 (9) ◽

pp. 790-794 ◽

Cited By ~ 2

Author(s):

Wesley Reintjes ◽

Marloes D.M. Romijn ◽

Daan Hollander ◽

Jan P. ter Bruggen ◽

Rob J. van Marum

Keyword(s):

Nursing Home ◽

Potassium Channel ◽

Limbic Encephalitis ◽

Voltage Gated ◽

Nursing Home Patients

Download Full-text

THUR 153 Antibodies against the voltage-gated potassium channel complex

Journal of Neurology Neurosurgery & Psychiatry ◽

10.1136/jnnp-2018-abn.65 ◽

2018 ◽

Vol 89 (10) ◽

pp. A18.2-A18

Author(s):

Joyutpal Das ◽

Vanisha Chauhan ◽

Ryan Keh ◽

Daniel Mills ◽

Johal Nicholas ◽

...

Keyword(s):

Potassium Channel ◽

Intravenous Immunoglobulins ◽

Voltage Gated ◽

Morvan’S Syndrome ◽

Classic Phenotype ◽

Antibody Titres ◽

Peripheral Nerve Hyperexcitability ◽

Clinical Phenotyping ◽

Positive Results ◽

Autoimmune Encephalopathy

Voltage-gated potassium channel (VGKC) complex antibodies have been associated with a spectrum of presentations including peripheral nerve hyperexcitability (PNH), Morvan’s syndrome, autoimmune encephalopathy, epilepsy and recently psychosis.We retrospectively reviewed the medical records of 70 patients from the Greater Manchester Neuroscience Centre, who had tested positive for VGKC-complex antibodies between 2012 and 2015 to identify the clinical relevance of positive results.The majority were diagnosed with autoimmune encephalopathy(19) followed by epilepsy(14), psychosis(10) and PNH(6). The remaining fifteen had other neurological presentations and six had no primary neurological disorder. 39/70 patients who had antibody titres>400 pM, were diagnosed with autoimmune encephalopathy(19), epilepsy(9), psychosis(4), PNH(3) and other disorders(4). 24/39 patients, who received treatment with one or a combination of corticosteroids, intravenous immunoglobulins, cyclophosphamide, plasma exchange, azathioprine or rituximab, had a diagnosis of autoimmune encephalopathy(18), epilepsy(2), psychosis(2) and malignancy(2). 16/24 were treatment responsive. 3/31 patients with lower titres were also treated, but only one with the classic phenotype (PNH) responded to treatment.The classic phenotype often had a titre >400 pM. PNH may have a titre ≤400 pM. The patients without classic presentations typically had titres≤400 pM. Consistent with previous studies, clinical phenotyping and antibody titre helped to determine the relevance of VGKC-complex antibodies.

Download Full-text

Anti-voltage-gated potassium channel complex antibody–mediated limbic encephalitis: a case report of a 53-year-old man admitted to intensive care psychiatric unit with psychotic mania

General Psychiatry ◽

10.1136/gpsych-2020-100196 ◽

2020 ◽

Vol 33 (4) ◽

pp. e100196

Author(s):

Homayun Shahpesandy ◽

Rosemary Mohammed-Ali ◽

Ahmed Oladosu ◽

Tarik Al-Kubaisy ◽

Moses Anene ◽

...

Keyword(s):

Potassium Channel ◽

Medial Temporal Lobe ◽

Short Term Memory ◽

Limbic Encephalitis ◽

Neuropsychiatric Symptoms ◽

Autoimmune Encephalitis ◽

Clonic Seizure ◽

Neurological Symptoms ◽

Psychiatric Symptomatology ◽

Voltage Gated

Limbic encephalitis represents a cluster of autoimmune disorders, with inflammation in the medial temporal lobe characterised by subacute onset of neuropsychiatric symptoms such as anxiety, affective symptoms, psychosis, short-term memory impairment as well as faciobrachial and grand mal seizures. We aim to present a case of a 53-year-old man with positive anti–voltage-gated potassium channel (VGKC) complex antibodies who initially presented with symptoms of psychotic mania. Six weeks post-psychiatric symptomatology, he presented with neurological symptoms such as faciobrachial jerking and tonic-clonic seizure. The patient had no previous psychiatric history and was initially treated with psychotropic medications. Our experience emphasises the fact that limbic encephalitis is not easy to identify as most patients initially present with psychiatric symptomatology than neurological symptoms. Furthermore, immunological and laboratory testing takes a rather long time to determine the diagnosis. What is more, few psychiatrists consider autoimmune nature of the neuropsychiatric presentation. Therefore, it is important to consider autoimmune encephalitis in patients with new-onset psychosis or mania who also present with neurological symptoms at some stage of their illness. Characteristic indicators of autoimmune encephalitis include neurological symptoms such as facial twitching, seizures, confusion and cognitive decline.

Download Full-text

Voltage-Gated Potassium Channel Antibodies is a Sign of Limbic Encephalitis

Journal of the Turkish Epilepsi Society ◽

10.5505/epilepsi.2015.43265 ◽

2015 ◽

Author(s):

Aylin BIICAN DEMIR

Keyword(s):

Potassium Channel ◽

Limbic Encephalitis ◽

Voltage Gated

Download Full-text

Advances in Treatment Options for High-grade Glioma - Current Status and Future Perspectives

European Neurological Review ◽

10.17925/enr.2010.05.01.49 ◽

2010 ◽

Vol 5 (1) ◽

pp. 49 ◽

Cited By ~ 1

Author(s):

Ryan T Merrell ◽

Eudocia C Quant ◽

Patrick Y Wen ◽

◽

...

Keyword(s):

Anaplastic Astrocytoma ◽

Brain Tumours ◽

Treatment Options ◽

High Grade Glioma ◽

Current Status ◽

High Grade ◽

Novel Therapies ◽

Targeted Agents ◽

Future Perspectives ◽

Primary Brain Tumours

High-grade gliomas, including glioblastoma, anaplastic astrocytoma, anaplatic oligodendroglioma and anaplastic oligoastrocytoma, account for the majority of malignant primary brain tumours diagnosed in adults. The prognosis for these tumours is poor despite multimodality therapy with surgery, radiation and/or chemotherapy. This review summarises treatment options for high-grade glioma, including standard regimens, targeted agents and novel therapies.

Download Full-text