Home > Publications Database > Cognitive Deficits in Anti-LGI1 Encephalitis Are Linked to Immunotherapy-Resistant White Matter Network Changes. > print

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005     20250412100028.0
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082 _ _ |a 610
100 1 _ |a Krohn, Stephan
|0 0000-0003-0683-5386
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245 _ _ |a Cognitive Deficits in Anti-LGI1 Encephalitis Are Linked to Immunotherapy-Resistant White Matter Network Changes.
260 _ _ |a Philadelphia, Pa.
|c 2025
|b Wolters Kluwer
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520 _ _ |a Cognitive deficits represent a major long-term complication of anti-leucine-rich, glioma-inactivated 1 encephalitis (LGI1-E). Although severely affecting patient outcomes, the structural brain changes underlying these deficits remain poorly understood. In this study, we hypothesized a link between white matter (WM) networks and cognitive outcomes in LGI1-E.In this cross-sectional study, we combined clinical assessments, comprehensive neuropsychological testing, diffusion tensor MRI, probabilistic WM tractography, and computational network analysis in patients with LGI1-E referred to Charité-Universitätsmedizin Berlin. Healthy individuals were recruited as control participants and matched to patients for age and sex with logistic regression propensity scores.Twenty-five patients with LGI1-E (mean age = 63 ± 12 years, 76% male) and 25 healthy controls were enrolled. Eighty-eight percent of patients presented persistent cognitive symptoms at postacute follow-up (median: 12 months from onset, interquartile range: 6-23 months)-despite treatment with immunotherapy and good overall recovery (modified Rankin Scale [mRS] score at peak illness vs postacute: z = -4.1, p < 0.001, median mRS score at postacute visit: 1). Neuroimaging revealed that WM networks in LGI1-E are characterized by (1) a systematic reduction in whole-brain connectivity (t = -2.16, p = 0.036, d = -0.61), (2) a cortico-subcortical hypoconnectivity cluster affecting both limbic and extralimbic brain systems, and (3) a 'topological reorganization' marked by a bidirectional shift in the relative importance of individual brain regions in the WM network. The extent of this WM reorganization was strongly associated with long-term deficits of verbal memory (r = -0.56), attention (r = -0.55), and executive functions (r = -0.60, all pFDR = 0.017).Although traditionally viewed as a form of limbic encephalitis, our study characterizes LGI1-E as a 'network disorder' that affects the whole brain. Structural reorganization of WM networks was linked to long-term and multidomain cognitive impairment, which was not prevented by immunotherapy. These findings highlight the need for closer monitoring and improved treatment strategies to mitigate long-term cognitive impairment in LGI1-E.
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650 _ 7 |a LGI1 protein, human
|2 NLM Chemicals
650 _ 7 |a anti-leucine-rich glioma-inactivated 1 autoantibody
|2 NLM Chemicals
650 _ 7 |a Intracellular Signaling Peptides and Proteins
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650 _ 7 |a Autoantibodies
|2 NLM Chemicals
650 _ 2 |a Humans
|2 MeSH
650 _ 2 |a Male
|2 MeSH
650 _ 2 |a Female
|2 MeSH
650 _ 2 |a Middle Aged
|2 MeSH
650 _ 2 |a White Matter: diagnostic imaging
|2 MeSH
650 _ 2 |a White Matter: pathology
|2 MeSH
650 _ 2 |a Cognitive Dysfunction: etiology
|2 MeSH
650 _ 2 |a Cognitive Dysfunction: physiopathology
|2 MeSH
650 _ 2 |a Cognitive Dysfunction: diagnostic imaging
|2 MeSH
650 _ 2 |a Aged
|2 MeSH
650 _ 2 |a Cross-Sectional Studies
|2 MeSH
650 _ 2 |a Immunotherapy: methods
|2 MeSH
650 _ 2 |a Nerve Net: diagnostic imaging
|2 MeSH
650 _ 2 |a Nerve Net: physiopathology
|2 MeSH
650 _ 2 |a Nerve Net: pathology
|2 MeSH
650 _ 2 |a Encephalitis: diagnostic imaging
|2 MeSH
650 _ 2 |a Encephalitis: immunology
|2 MeSH
650 _ 2 |a Intracellular Signaling Peptides and Proteins
|2 MeSH
650 _ 2 |a Autoantibodies: blood
|2 MeSH
650 _ 2 |a Diffusion Tensor Imaging
|2 MeSH
700 1 _ |a Müller-Jensen, Leonie
|0 0000-0002-6388-9375
|b 1
700 1 _ |a Kuchling, Joseph
|b 2
700 1 _ |a Romanello, Amy
|0 0000-0003-1257-9593
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700 1 _ |a Wurdack, Katharina
|0 0000-0003-0952-5658
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700 1 _ |a Rekers, Sophia
|0 0000-0002-6161-6621
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700 1 _ |a Bartsch, Thorsten
|0 0000-0001-8387-5731
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700 1 _ |a Leypoldt, Frank
|0 0000-0002-8972-515X
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700 1 _ |a Paul, Friedemann
|0 0000-0002-6378-0070
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700 1 _ |a Ploner, Christoph J
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700 1 _ |a Prüss, Harald
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700 1 _ |a Finke, Carsten
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773 _ _ |a 10.1212/NXI.0000000000200360
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|t Neurology: Neuroimmunology & Neuroinflammation ; official journal of the American Academy of Neurology
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