Inflammation of the limbic system, or also limbic encephalitis (LE), is an inflammation of the part of the nervous system that is primarily responsible for emotions. Therefore, symptoms of inflammation of the limbic system may suggest mental illness, which may delay diagnosis. This poses a he alth risk to the patient as LE is often indicative of cancer development. What are the causes and symptoms of inflammation of the limbic system? What is the treatment?

Inflammation of the limbic system(limbic encephalitis, LE), otherwiselimbic encephalitisorlimbic encephalitis or marginalis inflammation of the part of the nervous system that is responsible for emotions (e.g. satisfaction, pleasure or fear), drives motivational behavior, and is responsible for memory and learning processes.

  • Limbic system: structure and functions

Inflammation of the limbic system - causes

Limbic encephalitis belongs to the group of neurological paraneoplastic syndromes. These are disorders of the nervous system resulting from the malfunctioning of the immune system caused by the presence of a tumor.

Neurological paraneoplastic syndromes do not result from the local, direct action of the tumor or metastases to the nervous system, because the primary tumor or its metastases are located outside the nervous system.

Primary cancer is diagnosed in more than half of patients with limbic system inflammation - most often (40% of cases) lung cancer (small cell), testicular cancer (20%), breast cancer (8%).

Inflammation of the limbic system can also develop in the course of Hodgkin's disease, thymoma and teratoma.

Inflammation of the limbic system - symptoms

In the early stages of development, inflammation of the limbic system does not show any characteristic symptoms. Patients may initially complain about the so-called flu-like symptoms: headaches, fever, etc. At a later stage, symptoms such as:

  • disorientation, confusion, agitation
  • short-term memory disorder or amnesia

Symptoms of limbic inflammation usually appear 3-5 months before the symptoms of the primary tumor

  • mental disorders - psychosis (visual and auditory hallucinations)
  • depression
  • generalized or focal seizures (about 50% of patients)
  • sleep disturbance
  • less common: chorea, myoclonus

Inflammation of the limbic system - diagnosis

When limbic encephalitis is suspected, neuroimaging (computed tomography of the head, magnetic resonance imaging of the head, EEG) and cerebrospinal fluid tests are performed.

Patients with inflammation of the limbic system often require a psychiatric consultation in order to exclude a mental illness.

Blood tests are also required to check if the patient hasonconeural antibodies . These are antibodies produced by the immune system to fight cancer cells, which also mistakenly attack structures in the nervous system.

If onconeuronal antibodies against intracellular antigens are detected in the blood, this suggests a paraneoplastic nature of inflammation of the limbic system.

In the differential diagnosis of limbic system inflammation, it is also necessary to take into account causes of the disease other than neoplasms.

Important

Neurological symptoms in patients with the presence of onconeuronal antibodies often precede the symptoms of neoplasm, therefore the detection of these antibodies in tests should be a signal for the doctor to look for a neoplasm.

Inflammation of the limbic system - treatment

  • Cancer treatment

If a patient is diagnosed with cancer, treatment is the most important element of treatment.

  • Immunomodulating treatment

The patient is given intravenous methylprednisolone for 3-5 days, followed by oral prednisone and intravenous immunoglobulins.

If treatment is unsuccessful, consider 3 to 5 plasmapheresis treatments (cleansing the blood of undesirable elements) or switching to second-line therapy (cyclophosphamide, rituximab) within 1-3 weeks of follow-up.

  • Symptomatic treatment

The patient is given antiepileptic and neuroleptic drugs.

Inflammation of the limbic system is a severe but curable disease. Importantly, the changes in the nervous system caused may be reversible. The greater the chances of this happening, the earlier the disease is diagnosed and the sooner the appropriate treatment is implemented.

Sources:

  1. Rybacka-Mossakowska J., Wyciszkiewicz A., Michalak S., Diagnostic and treatment problems in patients with encephalomyelitis, "Anestezjologia i Ratownictwo" 2014, no. 8.
  2. www.antyneuronalne.pl

Category:

Neurology