A case series of patients with LGI1 cognitive deterioration

CSF- and serum-borne autoantibodies against brain proteins are known to cause a wide range of cognitive sequelae due autoimmune attack. For example, when antibodies are raised against the protein LGI1, which is thought to act as a voltage-gated K+ channel, a common result is encephalopathy.

As a result, LGI1 is often included in autoimmune panels, along with several other proteins including CASPR2, NMDA and AMPA subunits, GABA-B receptors, GAD65, CRMp-5, ANNA-1, and ANNA-2.

Recently, Ariño et al presented a summary of 76 patients with LGI1-associated cognitive deterioration, 13% of which had forms of cognitive deterioration distinct from limbic encephalitis. At 2 years their major outcomes were:

  • 35% fully recovered
  • 35% regained independence but to baseline levels
  • 23% required assistance due to cognitive defects
  • 6% died

In mice, LGI1 is primary expressed at the RNA level in neurons at the RNA level, while in humans its expressed in both mature astrocytes and neurons (data from here and here), eg in the Darmanis et al 2015 human data set its actually expressed higher in astrocytes:

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It might be interesting to see whether encephalopathies are generally only caused by autoantibodies against proteins expressed in neurons, or whether or cell type-expressed proteins can also lead to a similar clinical outcome.