{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,18]],"date-time":"2025-12-18T09:10:48Z","timestamp":1766049048819,"version":"3.48.0"},"reference-count":0,"publisher":"Jaypee Brothers Medical Publishing","issue":"11","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAPI"],"published-print":{"date-parts":[[2025,11,10]]},"abstract":"<jats:p>A 54-year-old female presented with recurrent episodes of altered sensorium. The episodes \nlasted 4\u20136 minutes with snoring and unresponsiveness, and confusion during resolution. She \nwas found to have recurrent hyponatremia and hypoglycemia. The hyponatremia was hypo\nosmotic with raised urinary sodium excretion managed with hypertonic saline and oral extra \nsalt. Electroencephalogram (EEG) showed epileptiform discharges. The recurrent seizure episodes \npersisted in spite of antiepileptic drugs. Cerebrospinal fluid (CSF) examination showed: glucose \n174.7 mg\/dL, protein 60.4 mg\/dL, total leukocyte count (TLC) 5. acid-fast bacilli (AFB), Gram stain\u2014\nno organism, culture sensitivity sterile, Cryptococcus antigen, cobwebbing absent, BioFire CSF \nmeningitis\/encephalitis panel was negative. Serum autoimmune encephalitis panel was positive \nfor leucine-rich glioma-inactivated 1 (LGI1) antibody (2+) (titer 1:10). The patient was initially \ntreated with IV immunoglobulin 170 gm over 5 days. The nonconvulsive seizure activity reduced \nbut remained persistent. The patient was further treated for syndrome of inappropriate antidiuretic \nhormone secretion (SIADH)-induced hyponatremia with fluid restriction and desmopressin. In view \nof persistent hyponatremia and altered sensorium, and positive autoimmune encephalitis panel, \nrituximab infusion was given on 2 occasions, 2 weeks apart. The sensorium showed a gradual but \nsignificant improvement with cessation of seizure activity and improved activities of daily living.\nOur patient presented with nonconvulsive seizure activity and persistent hyponatremia and \nrecurrent hypoglycemia. The anti-leucine-rich glioma inactivated 1 (LGI1 antibody) is a rarely \nfound entity first described in 2010. It is associated with electrolyte abnormalities, namely \nhyponatremia and hypoglycemia. A PubMed search revealed very few cases reported of \nLGI1 antibody encephalitis in association with nonconvulsive seizure activity. The electrolyte \nabnormalities associated with the entity make the management difficult. The recommended \nimmunosuppressive regimen consists of IV pulsed steroids, which was precluded in our patient \ndue to poorly controlled diabetes. Inadequate response seen after IVIg infusion prompted further \nimmunosuppression with rituximab. Satisfactory control of the seizure activity was attained after \nthe second rituximab dose.<\/jats:p>","DOI":"10.59556\/japi.73.1220","type":"journal-article","created":{"date-parts":[[2025,12,18]],"date-time":"2025-12-18T09:06:23Z","timestamp":1766048783000},"page":"47-49","source":"Crossref","is-referenced-by-count":0,"title":["An Unusual Case of Refractory Seizures"],"prefix":"10.59556","volume":"73","author":[{"given":"Mukhdoom Rakhshan Jameel","family":"Qureshi","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Monica","family":"Mahajan","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Vaibhav","family":"Rohatgi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Pranjali","family":"Gupta","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jyotsna","family":"Adeept","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Priyanka","family":"Priyadarshini","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"2914","published-online":{"date-parts":[[2025,11,10]]},"container-title":["Journal of the Association of Physicians of India"],"original-title":[],"deposited":{"date-parts":[[2025,12,18]],"date-time":"2025-12-18T09:06:25Z","timestamp":1766048785000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.japi.org\/article\/japi-73-11-s1-47"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,11,10]]},"references-count":0,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2025,11,10]]},"published-print":{"date-parts":[[2025,11,10]]}},"URL":"https:\/\/doi.org\/10.59556\/japi.73.1220","relation":{},"ISSN":["0004-5772"],"issn-type":[{"value":"0004-5772","type":"print"}],"subject":[],"published":{"date-parts":[[2025,11,10]]}}}