Tonic seizures: A diagnostic clue of anti-LGI1 encephalitis?
Bibliographic record
Abstract
# {#article-title-2} To the Editor: Andrade et al.1 described 3 patients with anti-LGI1 limbic encephalitis and abnormal movements involving different body regions. The authors stated that these paroxysmal attacks are tonic seizures and suggested that may indicate anti-LGI1 encephalitis.1 Features of tonic seizures include the following: sudden-onset tonic extension or flexion of the head, trunk, or extremities; duration of less than 60 seconds; varying degrees of impairment of consciousness; and occurrence either shortly after the person falls asleep or just after awakening.2 In the EEG, the ictal correlate of tonic seizures is an electrodecremental response: a high-frequency discharge in the β frequency with relatively low amplitude. Moreover, EMG activity is dramatically increased in tonic seizures. Unfortunately, no EMG trace was available in the single ictal EEG recording reported by Andrade et al.1 While we agree that the motor movements in their patients were longer than myoclonic seizures, the extrapyramidal nature of these fits cannot be dismissed. The authors' ictal recordings did not identify definite EEG changes and the inconsistent response to different antiepileptic drugs (AEDs) also argues for an alternative, nonepileptic origin. Considering that these neurologic manifestations are not readily evocative of any seizure type currently recognized by the International League Against Epilepsy classification, Irani et al.3 termed them faciobrachial dystonic seizures. Most of their patients' neuroimaging studies showed altered glucose metabolism in different cerebral regions including the basal ganglia. They also acknowledged that “it seems likely that the ictal dystonia in these patients reflects basal ganglia involvement.”3 Neurophysiologic characterization of these attacks by multichannel EEG-EMG recordings and jerk-locked back averaging analysis are needed to clarify the nature of attacks and affected brain areas before definitely considering them “epileptic.” However, the distinctive semiology should prompt testing for VGKC-complex/Lgi1 antibodies and possible immunotherapy.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.011 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.002 | 0.001 |
| Bibliometrics | 0.002 | 0.001 |
| Science and technology studies | 0.001 | 0.002 |
| Scholarly communication | 0.002 | 0.003 |
| Open science | 0.004 | 0.001 |
| Research integrity | 0.011 | 0.009 |
| Insufficient payload (model declined to judge) | 0.004 | 0.003 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".