Contemporary Encephalitis Lethargica: Phenotype, laboratory findings and treatment outcomes

Robert Lopez-Alberola, Michael Georgiou, George N. Sfakianakis, Carlos Singer, Spyridon Papapetropoulos

Research output: Contribution to journalArticle

23 Scopus citations

Abstract

Background : Encephalitis lethargica (EL) is a CNS disorder that manifests with lethargy sleep cycle disturbances, extrapyramidal symptomatology, neuropsychiatric manifestations, ocular features and cardio-respiratory abnormalities. Although there have been no reported outbreaks of EL recently, a number of reports show that cases of EL are still encountered regularly. Against this background we conducted a study aiming to elucidate the clinical characteristics, describe laboratory/ neuroimaging findings (MRI, PET) and present treatment options and outcomes in sporadic EL. Methods : Patients were diagnosed over a period of 3 years using proposed diagnostic criteria. Extensive laboratory and imaging tests were performed for exclusion of other causes. Anti-neuronal antibodies against human basal ganglia were detected with western immunoblotting and 18F-FDG PET imaging was performed. Selected cases were videotaped. Results : Our patients (M/F: 5/3) ranged from 2-28 years (mean 9.3 ± 9.5). Encephalopathy, sleep disturbances and extrapyramidal symptoms were present in all cases. Laboratory investigations revealed CSF leukocytosis in 5/8 patients and anti-BG Ab in 4/7 patients. MRIs revealed structural abnormalities in 7/8 cases. 18F-FDG PET showed basal ganglionic hypermetabolism in 4/7 patients. Treatment approaches included immunomodulating and symptomatic therapies. We report no mortality from EL in our series. Conclusions : There seems to be little doubt that cases of EL still occur. Diagnosis may be based on clinical suspicion and laboratory/imaging tests may lead to early initiation of immunomodulating and supporting therapies. We suggest that in addition to anti-BG Abs FDG PET should be considered as a diagnostic tool for EL.

Original languageEnglish (US)
Pages (from-to)396-404
Number of pages9
JournalJournal of Neurology
Volume256
Issue number3
DOIs
StatePublished - Mar 1 2009

Keywords

  • Anti-basal ganglia antibodies
  • Encephalitis Lethargica
  • MRI
  • PET
  • Treatment

ASJC Scopus subject areas

  • Clinical Neurology
  • Neurology

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