Abstract Details

Title Paraneoplastic Autoimmune Encephalitis Due To Amphiphysin Antibodies Manifesting As Focal Seizures With Convulsive Status Epilepticus In a Patient With Small Cell Lung Carcinoma

Topic Autoimmune Neurology

Presentation(s) Autoimmune Neurology Posters (7:00 AM-5:00 PM)

Poster/Presentation
Number 103

Objective To report a case of paraneoplastic autoimmune encephalitis with amphiphysin antibodies manifesting as focal temporal lobe seizures with impaired awareness and convulsive status epilepticus in a patient with small cell lung carcinoma

Background Amphiphysin antibodies are associated with paraneoplastic syndromes and most commonly present as stiff person syndrome. Autoimmune encephalitis presenting as status epilepticus with positive amphiphysin antibodies due to small cell cancer has not been previously reported

Design/Methods

Results

A 73-year-old, right-handed man with history of hypertension and hyperlipidemia who had progressive ataxia, Déjà vu and encephalopathy for 6 months presented to our inpatient service due to temporal lobe focal seizures with impaired awareness with convulsive status epilepticus

MRI (magnetic resonance imaging) with and without contrast was normal, lumbar puncture revealed 4 white blood cells, proteins of 75 and paraneoplastic panel in cerebrospinal fluid (CSF) was positive for amphiphysin antibodies with a titer of 1:256. Patient was started on levetiracetam and oxcarbazepine along with intravenous methylprednisolone 1 gram daily for 5 days with some improvement, however he continued to be encephalopathic and had persistence of seizures. Plasmapheresis (PLEX) was then started for a total of 5 sessions which led to significant improvement of encephalopathy and resolution of seizures. Computed tomography (CT) of chest showed right paratracheal lymph nodes in the superior mediastinum and enlarged precarinal lymph nodes. Lymph node biopsy revealed small cell carcinoma with PET scan devoid of metastasis. Oncology team recommended a 3-day course of etoposide

Conclusions To our knowledge, this is the first case of paraneoplastic autoimmune encephalitis associated with amphiphysin antibodies presenting with status epilepticus

Authors/Disclosures
Gina S. Perez-Giraldo, MD PRESENTER	Dr. Perez-Giraldo has received personal compensation for serving as an employee of TG therapeutics. Dr. Perez-Giraldo has received personal compensation in the range of $500-$4,999 for serving as a Consultant for TG therapeutics.
Ahmer Asif, MD	Dr. Asif has nothing to disclose.
Ahmad Al-Awwad, MD (University of Oklahoma)	Dr. Al-Awwad has nothing to disclose.
Evgeny Sidorov, MD (University of Oklahoma Hlth Sci Ctr)	Dr. Sidorov has nothing to disclose.
David L. Gordon, MD, FAHA, FANA, FAAN (University of Oklahoma HSC)	Dr. Gordon has nothing to disclose.
Nidhiben A. Anadani, MD (University Of Oklahoma Health Science Center)	Dr. Anadani has nothing to disclose.

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