Diagnosis and treatment of limbic encephalitis in the cancer patient

Future Oncol. 2020 Aug;16(22):1647-1655. doi: 10.2217/fon-2020-0080. Epub 2020 Jun 8.

Abstract

Limbic encephalitis is an inflammatory process involving the limbic structures of the brain, manifested with short-term memory deficits, confusion, depression and seizures. It is usually a paraneoplastic condition but it may also appear as a nonparaneoplastic syndrome. Patients with this condition may exhibit a variety of antibodies in their serum or/and cerebrospinal fluid targeting basement membrane components that bind to a variety of neurotransmitter receptors such as α-amino-3-hydroxy-5-methyl-4-isoxazole propionic acid and GABA B and proteins associated to the ion channels such as LGI1, Caspr2 or intracellular components. Flurodeoxyglucose PET/computed tomography usually demonstrates increased uptake in the limbic structures, and it may reveal the site of the primary tumor. Treatment consists of tumor removal if possible. Symptomatic treatment includes steroids, gamma immune globulin, plasma exchange, immunosuppressive therapies and anti-epileptic drugs. Prognosis is better when it is associated with antibodies against basement membrane rather than intracellular antibodies.

Keywords: FDG PET/CT; epilepsy; limbic encephalitis; paraneoplastic antibody; paraneoplastic neurological syndrome.

Publication types

  • Review

MeSH terms

  • Anticonvulsants / therapeutic use
  • Autoantibodies / blood
  • Fluorodeoxyglucose F18
  • Humans
  • Limbic Encephalitis / complications
  • Limbic Encephalitis / diagnosis*
  • Limbic Encephalitis / immunology
  • Limbic Encephalitis / therapy*
  • Neoplasms / complications*
  • Positron Emission Tomography Computed Tomography
  • Seizures / drug therapy

Substances

  • Anticonvulsants
  • Autoantibodies
  • Fluorodeoxyglucose F18