Striking basal ganglia imaging abnormalities in LGI1 ab faciobrachial dystonic seizures

Autoimmune encephalitis associated with antibodies targeting the neuronal surface antigen leucine-rich, glioma-inactivated 1 (LGI1) protein is accompanied by faciobrachial dystonic seizures (FBDS) in up to half of patients. These hallmark episodes can be mistaken for psychiatric disorders, particularly as the ictal episodes are usually not detectable with surface EEG electrodes. Accompanying imaging abnormalities help exclude psychiatric etiologies, localize the seizures, and improve our understanding of the pathogenesis. Herein, we present striking imaging abnormalities in a patient with FBDS from LGI1-antibody encephalitis.