Drop attacks: A clinical manifestation of LGI1 encephalitis

We describe a clinical manifestation of leucine-rich glioma-inactivated-1 (LGI1) encephalitis. The patient was a 90-year-old woman, independent at baseline, with a medical history of hypertension. Two months prior to admission, she had an unwitnessed fall and was found after an unknown period of unconsciousness. She was taken to an outside hospital where rhabdomyolysis (creatine kinase >16,000, reference 24–170 U/L) was documented. During that admission, she had a witnessed generalized tonic-clonic seizure. Prolonged EEG video monitoring captured multiple episodes of right leg jerking without a change in her consciousness or an abnormal EEG correlate. Interictal EEG findings were unremarkable. A metabolic panel showed mild hyponatremia (133; reference 137–145 mmol/L). MRI of the brain was unremarkable. CSF analysis was normal (leukocytes 3/mm3, protein 45 mg/dL, and glucose 80 mg/dL). She was discharged home on levetiracetam (1,500 mg daily) and did not have any further documented convulsions, but reported hypersomnolence.