Incidental Detection of Anti-IgLON5: A Diagnostic and Therapeutic Dilemma (P5-5.021)
Bibliographic record
Abstract
Objective: To report a patient in whom anti-IgLON5 was incidentally detected as part of work-up for possible autoimmune-associated epilepsy. Background: Anti-IgLON5 disease has recently been characterized. Core manifestations include sleep disturbances, bulbar dysfunction, gait instability, chorea and cognitive decline, while seizures are not typical. Response to immunotherapy is usually suboptimal and prognosis is frequently poor, although early treatment could improve outcomes. Design/Methods: Case report. Results: A 49-year-old woman had an 18-year-history of temporal lobe epilepsy that developed after cervical cancer. Brain MRI was unremarkable but EEG showed right temporal epileptiform discharges and PET showed right temporal hypometabolism, compatible with right temporal seizure origin. Due to seizure refractoriness and history of cancer, comprehensive neural antibody testing for possible autoimmune-associated epilepsy was pursued and revealed anti-IgLON5 in serum and cerebrospinal fluid. On directed history, the patient reported snoring and insomnia that had developed two years prior, which were symptoms she had not initially volunteered because she felt they were mild and stable. Neurologic examination was unremarkable. The patient received a six-week trial of corticosteroids, without improvement in seizure frequency or sleep disturbances. Polysomnography revealed minimal sleep disordered breathing, mild arousals from slow wave sleep, unusually prominent beta activity in REM sleep, and excessive fragmentary myoclonus, which may represent early anti-IgLON5 disease. Conclusions: Diagnostically, we hypothesize that anti-IgLON5 is unrelated to chronic temporal lobe epilepsy in our patient, which we suspect is idiopathic. However, this antibody may explain sleep findings, and the mildness of her symptoms referable to anti-IgLON5 disease creates a unique therapeutic dilemma. In discussion with the patient, we have opted to monitor clinically and with polysomnography, and to consider institution of further immunotherapy if there is demonstrable disease progression. Future study into the natural history of anti-IgLON5 disease is needed to determine the optimal management of patients with mild symptoms. Disclosure: Dr. Alkabie has nothing to disclose. The institution of Dr. Murray has received research support from Wake Up Narcolepsy. Dr. Murray has received publishing royalties from a publication relating to health care. Dr. Budhram has nothing to disclose.
Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.
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 | 0.003 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.002 | 0.001 |
| Scholarly communication | 0.001 | 0.002 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.006 | 0.003 |
| Insufficient payload (model declined to judge) | 0.002 | 0.001 |
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".