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LGI1 Encephalitis Maintenance — RACP Adult Medicine MCQ

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HardNeurologyLGI1 Encephalitis MaintenanceRACP Adult Medicine

A 65-year-old man with LGI1 limbic encephalitis (faciobrachial dystonic seizures, cognitive decline, hyponatraemia) is started on IV methylprednisolone. His FBDS respond within 48 hours. What is the most appropriate maintenance immunotherapy?

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Correct answer: B — Rituximab

LGI1 encephalitis responds well to first-line immunotherapy (corticosteroids). FBDS often respond dramatically within days. However, relapse rates are high (20-30%) on steroid tapering. Rituximab is increasingly used as maintenance to allow steroid weaning and prevent relapse. Long-term immunosuppression (12-24 months) is typically needed.

Reference: Lancet Neurol 2024 Autoimmune Encephalitis; eTG Neurology 2024