{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,14]],"date-time":"2026-05-14T15:00:47Z","timestamp":1778770847804,"version":"3.51.4"},"reference-count":38,"publisher":"MDPI AG","issue":"6","license":[{"start":{"date-parts":[[2020,6,16]],"date-time":"2020-06-16T00:00:00Z","timestamp":1592265600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"The article processing charge was funded by the German Research Foundation (DFG) and the University of Freiburg in the funding program Open Access Publishing.","award":["na"],"award-info":[{"award-number":["na"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Brain Sciences"],"abstract":"<jats:p>Background: Anti-leucine-rich glioma-inactivated 1 (LGI1) encephalitis is typically characterized by limbic encephalitis, faciobrachial dystonic seizures and hyponatremia. The frequency with which milder forms of anti-LGI1 encephalitis mimic isolated psychiatric syndromes, such as psychoses, or may lead to dementia if untreated, is largely unknown. Case presentation: Here, the authors present a 50-year-old patient who had suffered from neurocognitive deficits and predominant delusions for over one and a half years. He reported a pronounced feeling of thirst, although he was drinking 10\u201320 liters of water each day, and he was absolutely convinced that he would die of thirst. Due to insomnia in the last five years, the patient took Z-drugs; later, he also abused alcohol. Two years prior to admission, he developed a status epilepticus which had been interpreted as a withdrawal seizure. In his serum, anti-LGI1 antibodies were repeatedly detected by different independent laboratories. Cerebrospinal fluid analyses revealed slightly increased white blood cell counts and evidence for blood\u2013brain-barrier dysfunction. Magnetic resonance imaging showed hyperintensities mesio-temporally and in the right amygdala. In addition, there was a slight grey\u2013white matter blurring. A cerebral [18F] fluorodeoxyglucose positron emission tomography (FDG-PET) examination of his brain showed moderate hypometabolism of the bilateral rostral mesial to medial frontal cortices. Treatment attempts with various psychotropic drugs remained unsuccessful in terms of symptom relief. After the diagnosis of probable chronified anti-LGI1 encephalitis was made, two glucocorticoid pulse treatments were performed, which led to a slight improvement of mood and neurocognitive deficits. Further therapy was not desired by the patient and his legally authorized parents. Conclusion: This case study describes a patient with anti-LGI1 encephalitis in the chronified stage and a predominant long-lasting psychiatric course with atypical symptoms of psychosis and typical neurocognitive deficits. The patient\u2019s poor response to anti-inflammatory drugs was probably due to the delayed start of treatment. This delay in diagnosis and treatment may also have led to the FDG-PET findings, which were compatible with frontotemporal dementia (\u201cstate of damage\u201d). In similar future cases, newly occurring epileptic seizures associated with psychiatric symptoms should trigger investigations for possible autoimmune encephalitis, even in patients with addiction or other pre-existing psychiatric conditions. This should in turn result in rapid organic clarification and\u2014in positive cases\u2014to anti-inflammatory treatment. Early treatment of anti-LGI1 encephalitis during the \u201cinflammatory activity state\u201d is crucial for overall prognosis and may avoid the development of dementia in some cases. Based on this case, the authors advocate the concept\u2014long established in many chronic inflammatory diseases in rheumatology\u2014of distinguishing between an \u201cacute inflammatory state\u201d and a \u201cstate of organ damage\u201d in autoimmune psychosis resembling neurodegenerative mechanisms.<\/jats:p>","DOI":"10.3390\/brainsci10060375","type":"journal-article","created":{"date-parts":[[2020,6,16]],"date-time":"2020-06-16T13:20:43Z","timestamp":1592313643000},"page":"375","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":18,"title":["Psychiatric Manifestation of Anti-LGI1 Encephalitis"],"prefix":"10.3390","volume":"10","author":[{"given":"Dominique","family":"Endres","sequence":"first","affiliation":[{"name":"Section for Experimental Neuropsychiatry, Department of Psychiatry and Psychotherapy, Medical Center, Faculty of Medicine, University of Freiburg, 79104 Freiburg, Germany"},{"name":"Department of Psychiatry and Psychotherapy, Medical Center, Faculty of Medicine, University of Freiburg, 79104 Freiburg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Harald","family":"Pr\u00fcss","sequence":"additional","affiliation":[{"name":"Department of Neurology and Experimental Neurology, Charit\u00e9, Universit\u00e4tsmedizin Berlin, 10117 Berlin, Germany"},{"name":"German Center for Neurodegenerative Diseases (DZNE) Berlin, 10117 Berlin, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andrea","family":"Dressing","sequence":"additional","affiliation":[{"name":"Clinic of Neurology and Neurophysiology, Medical Center, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Johanna","family":"Schneider","sequence":"additional","affiliation":[{"name":"Renal Division, Department of Medicine, Medical Center, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bernd","family":"Feige","sequence":"additional","affiliation":[{"name":"Section for Experimental Neuropsychiatry, Department of Psychiatry and Psychotherapy, Medical Center, Faculty of Medicine, University of Freiburg, 79104 Freiburg, Germany"},{"name":"Department of Psychiatry and Psychotherapy, Medical Center, Faculty of Medicine, University of Freiburg, 79104 Freiburg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tina","family":"Schweizer","sequence":"additional","affiliation":[{"name":"Department of Psychiatry and Psychotherapy, Medical Center, Faculty of Medicine, University of Freiburg, 79104 Freiburg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7729-2759","authenticated-orcid":false,"given":"Nils","family":"Venhoff","sequence":"additional","affiliation":[{"name":"Department of Rheumatology and Clinical Immunology, Medical Center, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kathrin","family":"Nickel","sequence":"additional","affiliation":[{"name":"Section for Experimental Neuropsychiatry, Department of Psychiatry and Psychotherapy, Medical Center, Faculty of Medicine, University of Freiburg, 79104 Freiburg, Germany"},{"name":"Department of Psychiatry and Psychotherapy, Medical Center, Faculty of Medicine, University of Freiburg, 79104 Freiburg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sophie","family":"Meixensberger","sequence":"additional","affiliation":[{"name":"Section for Experimental Neuropsychiatry, Department of Psychiatry and Psychotherapy, Medical Center, Faculty of Medicine, University of Freiburg, 79104 Freiburg, Germany"},{"name":"Department of Psychiatry and Psychotherapy, Medical Center, Faculty of Medicine, University of Freiburg, 79104 Freiburg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Miriam","family":"Matysik","sequence":"additional","affiliation":[{"name":"Section for Experimental Neuropsychiatry, Department of Psychiatry and Psychotherapy, Medical Center, Faculty of Medicine, University of Freiburg, 79104 Freiburg, Germany"},{"name":"Department of Psychiatry and Psychotherapy, Medical Center, Faculty of Medicine, University of Freiburg, 79104 Freiburg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Simon","family":"Maier","sequence":"additional","affiliation":[{"name":"Section for Experimental Neuropsychiatry, Department of Psychiatry and Psychotherapy, Medical Center, Faculty of Medicine, University of Freiburg, 79104 Freiburg, Germany"},{"name":"Department of Psychiatry and Psychotherapy, Medical Center, Faculty of Medicine, University of Freiburg, 79104 Freiburg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Katharina","family":"Domschke","sequence":"additional","affiliation":[{"name":"Department of Psychiatry and Psychotherapy, Medical Center, Faculty of Medicine, University of Freiburg, 79104 Freiburg, Germany"},{"name":"Center for Basics in Neuromodulation, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Horst","family":"Urbach","sequence":"additional","affiliation":[{"name":"Department of Neuroradiology, Medical Center, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Philipp","family":"Meyer","sequence":"additional","affiliation":[{"name":"Department of Nuclear Medicine, Medical Center, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ludger","family":"Tebartz van Elst","sequence":"additional","affiliation":[{"name":"Section for Experimental Neuropsychiatry, Department of Psychiatry and Psychotherapy, Medical Center, Faculty of Medicine, University of Freiburg, 79104 Freiburg, Germany"},{"name":"Department of Psychiatry and Psychotherapy, Medical Center, Faculty of Medicine, University of Freiburg, 79104 Freiburg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2020,6,16]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1449","DOI":"10.1212\/WNL.0000000000003173","article-title":"Anti-LGI1 encephalitis: Clinical syndrome and long-term follow-up","volume":"87","author":"Thijs","year":"2016","journal-title":"Neurology"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"290","DOI":"10.1038\/nrneurol.2017.43","article-title":"The value of LGI1, Caspr2 and voltage-gated potassium channel antibodies in encephalitis","volume":"13","author":"Dalmau","year":"2017","journal-title":"Nat Rev Neurol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"840","DOI":"10.1056\/NEJMra1708712","article-title":"Antibody-Mediated Encephalitis","volume":"378","author":"Dalmau","year":"2018","journal-title":"N. Engl. J. Med."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"391","DOI":"10.1016\/S1474-4422(15)00401-9","article-title":"A clinical approach to diagnosis of autoimmune encephalitis","volume":"15","author":"Graus","year":"2016","journal-title":"Lancet Neurol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"970","DOI":"10.1016\/j.autrev.2016.07.018","article-title":"From VGKC to LGI1 and Caspr2 encephalitis: The evolution of a disease entity over time","volume":"15","author":"Schreurs","year":"2016","journal-title":"Autoimmun Rev."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1242","DOI":"10.1136\/jnnp-2015-313000","article-title":"Emerging psychiatric syndromes associated with antivoltage-gated potassium channel complex antibodies","volume":"87","author":"Lennox","year":"2016","journal-title":"J. Neurol. Neurosurg. Psychiatry"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"839","DOI":"10.1152\/physrev.00010.2016","article-title":"Autoantibodies to Synaptic Receptors and Neuronal Cell Surface Proteins in Autoimmune Diseases of the Central Nervous System","volume":"97","author":"Dalmau","year":"2017","journal-title":"Physiol Rev."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1203","DOI":"10.1007\/s00234-015-1581-x","article-title":"Supratentorial white matter blurring associated with voltage-gated potassium channel-complex limbic encephalitis","volume":"57","author":"Urbach","year":"2015","journal-title":"Neuroradiology"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"2744","DOI":"10.1007\/s00415-013-7048-2","article-title":"Cerebral FDG-PET and MRI findings in autoimmune limbic encephalitis: Correlation with autoantibody types","volume":"260","author":"Baumgartner","year":"2013","journal-title":"J. Neurol."},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Wegner, F., Wilke, F., Raab, P., Tayeb, S.B., Boeck, A.L., Haense, C., Trebst, C., Voss, E., Schrader, C., and Logemann, F. (2014). Anti-leucine rich glioma inactivated 1 protein and anti-N-methyl-D-aspartate receptor encephalitis show distinct patterns of brain glucose metabolism in 18F-fluoro-2-deoxy-d-glucose positron emission tomography. BMC Neurol., 14.","DOI":"10.1186\/1471-2377-14-136"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"279","DOI":"10.1186\/s12974-018-1314-2","article-title":"LGI1 expression and human brain asymmetry: Insights from patients with LGI1-antibody encephalitis","volume":"15","author":"Jang","year":"2018","journal-title":"J. Neuroinflamm."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"189","DOI":"10.1007\/s00234-017-1956-2","article-title":"Metabolic topography of autoimmune non-paraneoplastic encephalitis","volume":"60","author":"Tripathi","year":"2018","journal-title":"Neuroradiology"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"804","DOI":"10.3389\/fneur.2019.00804","article-title":"Cerebrospinal Fluid Findings in Patients with Autoimmune Encephalitis-A Systematic Analysis","volume":"10","author":"Blinder","year":"2019","journal-title":"Front Neurol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"405","DOI":"10.1002\/ana.25666","article-title":"Human Cerebrospinal Fluid Monoclonal LGI1 Autoantibodies Increase Neuronal Excitability","volume":"87","author":"Kornau","year":"2020","journal-title":"Ann. Neurol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"60","DOI":"10.1016\/j.yebeh.2017.06.039","article-title":"Increased rates of intermittent rhythmic delta and theta activity in the electroencephalographies of adult patients with attention-deficit hyperactivity disorder","volume":"75","author":"Endres","year":"2017","journal-title":"Epilepsy Behav."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"435","DOI":"10.1016\/S1053-8119(03)00346-X","article-title":"Predominant ventromedial frontopolar metabolic impairment in frontotemporal dementia","volume":"20","author":"Salmon","year":"2003","journal-title":"Neuroimage"},{"key":"ref_17","first-page":"1238","article-title":"A diagnostic approach in Alzheimer\u2019s disease using three-dimensional stereotactic surface projections of fluorine-18-FDG PET","volume":"36","author":"Minoshima","year":"1995","journal-title":"J. Nucl. Med."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"68","DOI":"10.1016\/j.neuroscience.2015.05.037","article-title":"Imaging of autoimmune encephalitis\u2014Relevance for clinical practice and hippocampal function","volume":"309","author":"Heine","year":"2015","journal-title":"Neuroscience"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"81","DOI":"10.1016\/j.bandc.2016.07.010","article-title":"Neuropsychological and FDG-PET profiles in VGKC autoimmune limbic encephalitis","volume":"108","author":"Dodich","year":"2016","journal-title":"Brain Cogn."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"90","DOI":"10.1016\/j.yebeh.2017.08.011","article-title":"Seizure semiology in leucine-rich glioma-inactivated protein 1 antibody-associated limbic encephalitis","volume":"77","author":"Chen","year":"2017","journal-title":"Epilepsy Behav."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"e1917","DOI":"10.1212\/WNL.0000000000008473","article-title":"Teaching NeuroImages: 18F-FDG-PET\/SPM analysis in 3 different stages from a patient with LGI-1 autoimmune encephalitis","volume":"93","author":"Shan","year":"2019","journal-title":"Neurology"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"195","DOI":"10.4172\/2155-9562.1000195","article-title":"Hyponatremia and Voltage Gated Potassium Channel Antibody Associated Limbic Encephalitis","volume":"5","author":"Newey","year":"2014","journal-title":"J. Neurol Neurophysiol."},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Black, N., and Hamada, H. (2018). Possible anti-VGKC autoimmune limbic encephalitis associated with SIADH. BMJ Case Rep., bcr\u20132017.","DOI":"10.1136\/bcr-2017-223484"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"328","DOI":"10.1007\/s00335-007-9024-6","article-title":"Defining the expression pattern of the LGI1 gene in BAC transgenic mice","volume":"18","author":"Head","year":"2007","journal-title":"Mamm. Genome."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"442","DOI":"10.1016\/S1474-4422(07)70104-7","article-title":"Wernicke\u2019s encephalopathy: New clinical settings and recent advances in diagnosis and management","volume":"6","author":"Sechi","year":"2007","journal-title":"Lancet Neurol."},{"key":"ref_26","first-page":"122","article-title":"Autoimmune encephalitis-Diagnostic and therapeutic decision tree from a psychiatric, neurological and ethico-legal point of view: Approach in cases of lack of ability to give consent and permissibility of compulsory treatment","volume":"91","year":"2020","journal-title":"Der Nervenarzt"},{"key":"ref_27","doi-asserted-by":"crossref","unstructured":"Ho, C.S.H., Ho, R.C.M., and Quek, A.M.L. (2018). Chronic Manganese Toxicity Associated with Voltage-Gated Potassium Channel Complex Antibodies in a Relapsing Neuropsychiatric Disorder. Int. J. Environ. Res. Public Health, 15.","DOI":"10.3390\/ijerph15040783"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"612","DOI":"10.1177\/1039856218771513","article-title":"LGI1 antibody encephalitis and psychosis","volume":"26","author":"Wang","year":"2018","journal-title":"Australas. Psychiatry"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"54","DOI":"10.3389\/fpsyt.2017.00054","article-title":"The Clinical Challenge of Autoimmune Psychosis: Learning from Anti-NMDA Receptor Autoantibodies","volume":"8","author":"Ellul","year":"2017","journal-title":"Front Psychiatry"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"25","DOI":"10.3389\/fpsyt.2017.00025","article-title":"Red Flags: Clinical Signs for Identifying Autoimmune Encephalitis in Psychiatric Patients","volume":"8","author":"Herken","year":"2017","journal-title":"Front Psychiatry"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"40","DOI":"10.1186\/s12974-018-1067-y","article-title":"A clinical approach to new-onset psychosis associated with immune dysregulation: The concept of autoimmune psychosis","volume":"15","author":"Najjar","year":"2018","journal-title":"J. Neuroinflamm."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"547","DOI":"10.1007\/s00115-019-0700-z","article-title":"Autoantibody-associated schizophreniform psychoses: Clinical symptomatology","volume":"90","author":"Endres","year":"2019","journal-title":"Der Nervenarzt"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"745","DOI":"10.1007\/s00115-019-0735-1","article-title":"Autoantibody-associated schizophreniform psychoses: Pathophysiology, diagnostics, and treatment","volume":"90","author":"Bechter","year":"2019","journal-title":"Der Nervenarzt"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"93","DOI":"10.1016\/S2215-0366(19)30290-1","article-title":"Autoimmune psychosis: An international consensus on an approach to the diagnosis and management of psychosis of suspected autoimmune origin","volume":"7","author":"Pollak","year":"2020","journal-title":"Lancet Psychiatry"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"157","DOI":"10.1016\/S1474-4422(12)70310-1","article-title":"Treatment and prognostic factors for long-term outcome in patients with anti-NMDA receptor encephalitis: An observational cohort study","volume":"12","author":"Titulaer","year":"2013","journal-title":"Lancet Neurol."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"1528","DOI":"10.1001\/archneur.64.10.1528","article-title":"Potassium channel antibody associated encephalopathy presenting with a frontotemporal dementia like syndrome","volume":"64","author":"McKeon","year":"2007","journal-title":"Arch. Neurol."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"899","DOI":"10.1093\/rheumatology\/keq400","article-title":"A cross-sectional study of the Birmingham Vasculitis Activity Score version 3 in systemic vasculitis","volume":"50","author":"Suppiah","year":"2011","journal-title":"Rheumatology (Oxf.)"},{"key":"ref_38","doi-asserted-by":"crossref","unstructured":"Endres, D., Perlov, E., Stich, O., Rauer, S., Maier, S., Waldkircher, Z., Lange, T., Mader, I., Meyer, P.T., and van Elst, L.T. (2015). Hypoglutamatergic state is associated with reduced cerebral glucose metabolism in anti-NMDA receptor encephalitis: A case report. BMC Psychiatry, 15.","DOI":"10.1186\/s12888-015-0552-4"}],"container-title":["Brain Sciences"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2076-3425\/10\/6\/375\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T09:39:26Z","timestamp":1760175566000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2076-3425\/10\/6\/375"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,6,16]]},"references-count":38,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2020,6]]}},"alternative-id":["brainsci10060375"],"URL":"https:\/\/doi.org\/10.3390\/brainsci10060375","relation":{},"ISSN":["2076-3425"],"issn-type":[{"value":"2076-3425","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,6,16]]}}}