PMC9425832_01
Clinical and paraclinical features of the study case from symptoms onset to last follow-up. CASE, Clinical Assessment Scale in autoimmune Encephalitis; EEG, electroencephalography; 18F-FDG-PET, 18F-fluoridesoxyglucose-positron emission tomography; FBDS, faciobrachial dystonic seizures; IVIG, intravenous immunoglobulins; LGI1-abs, leucine-rich glioma-inactivated protein 1 antibodies; LTMV-EEG, long-term-monitoring video electroencephalography; MoCA, Montreal Cognitive Assessment; MRI, magnetic resonance imaging; mRS, modified Rankin Scale. Created with BioRender.com.
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In few weeks, these episodes increased in frequency to up to 12-24 times a day and were associated by rare generalized tonic-clonic seizures, leading to patient's hospitalization (timeline of the clinical and paraclinical features are shown in Figure 1).
18F-FDG-PET evolution. (A) 18F-FDG-PET after first-line immune therapy showing moderate right amygdala hypermetabolism and bilateral temporomesial, frontoanterior and frontomesial hypometabolism, suggestive for persistence of disease activity. (B) 18F-FDG-PET was repeated after 3 months from rituximab, showing an attenuation of amygdala hypermetabolism and at 10 months from rituximab (C), showing a complete regression of the amygdala hypermetabolism. 18F-FDG-PET, 18F-fluoridesoxyglucose-positron emission tomography.
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Moreover, brain 18F-FDG-PET showed moderate right amygdala hypermetabolism and bilateral temporomesial, frontoanterior and frontomesial hypometabolism in spite of the normal brain MRI scan (Figure 2A). PET scans showed progressive improvement of the alterations toward complete disappearance of the amygdala hypermetabolism up to 10-months after rituximab administration (Figures 2B,C).