A new cause of limbic encephalopathy

The spectrum of antibody-associated encephalopathy seems ever increasing. In 2004 Vincent et al . described, in this journal, a series of patients with a reversible limbic encephalopathy associated with antibodies against the voltage-gated potassium channels (VGKC-Ab). In this issue, Ances et al . (2005) have described yet another cause of limbic encephalopathy, this time a paraneoplastic disorder. Furthermore, they have suggested a classification to aid the physician in diagnosis and treatment and allow one to predict prognosis.Beau Ances and colleagues describe seven patients with the subacute onset of a limbic encephalopathy. The serum of one of their patients contained VGKC-Ab and resembled in all respects the patients described by Vincent et al . (2004). That patient did not have cancer and recovered after treatment with intravenous immunoglobulin and corticosteroids. As with the patients described by Vincent and colleagues the cerebrospinal fluid (CSF) did not contain white cells and there was no evidence of intrathecal synthesis of the antibody. The other six patients were different. Their serum and CSF contained an antibody that reacted not as in most previously described paraneoplastic syndromes with the nucleus …