Prolonged Corticosteroids Without Maintenance Immunotherapy for Treatment of Anti-LGI1 Encephalitis
Bibliographic record
Abstract
OBJECTIVES: To analyze outcomes and relapse rate of patients with anti-LGI1 encephalitis referred to the London Health Sciences Centre Autoimmune Neurology Clinic, where prolonged (≥3 months) corticosteroids without steroid-sparing maintenance immunotherapy are the typical treatment approach. METHODS: Retrospective chart review. RESULTS: Eighteen patients with anti-LGI1 encephalitis were identified. The median age at symptom onset was 65 years (interquartile range [IQR]: 62-70 years), and 13 (72%) were men. All patients received corticosteroids, with a median treatment duration of 6.3 months (IQR: 3.8-9.6 months). Other first-line immunotherapies used included IV immunoglobulin (n = 11, 61%) and plasma exchange (n = 2, 11%). Three patients referred for refractory disease received rituximab as second-line immunotherapy. No other steroid-sparing maintenance immunotherapies for anti-LGI1 encephalitis were prescribed. At last follow-up, 16/18 (89%) achieved seizure freedom, and 16/18 (89%) had a favorable modified Rankin Scale score. Among 9 patients who had ≥2 years of follow-up from symptom onset, there was disease relapse in 3 (33%), 2 of whom had been referred for refractory disease. DISCUSSION: Among our patients with anti-LGI1 encephalitis who typically received prolonged corticosteroids without steroid-sparing maintenance immunotherapy, outcomes were generally favorable, and relapses were uncommon outside of refractory disease. Further investigation is needed to clarify the optimal corticosteroid regimen and role of steroid-sparing maintenance immunotherapy in anti-LGI1 encephalitis.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
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 teacher head, 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".