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<p>Leucine-rich glioma-inactivated 1 (LGI1) antibody–associated encephalitis typically presents with focal seizures, memory impairment, psychiatric symptoms, and hyponatremia. Sleep disturbances—such as insomnia, hypersomnia, and rapid eye movement (REM) sleep behavior disorder—are increasingly recognized within its clinical spectrum. Oneiric stupor, characterized by stereotyped gestures mimicking everyday activities, is a core manifestation of agrypnia excitata but has only rarely been reported in association with LGI1 encephalitis.</p><p>We report a previously healthy 78-year-old man who presented with prominent sleep disturbances following epileptic seizures, insomnia, and psychiatric symptoms. After an initial period of drowsiness and confusion, his clinical course rapidly evolved to fluctuating sleep–wake–like states accompanied by involuntary simple and complex behaviors resembling daily life activities, consistent with oneiric stupor. Anti-LGI1 antibodies were detected in both cerebrospinal fluid and serum. Following immunotherapy, neuropsychiatric symptoms, including oneiric stupor, resolved completely.</p><p>This case demonstrates that oneiric stupor, although a rare manifestation, may predominate the clinical presentation in the advanced stage of LGI1 antibody–associated encephalitis. This distinctive clinical finding may aid in raising diagnostic suspicion and is reversible following treatment initiation.</p>

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Oneiric stupor as a clinical manifestation of LGI1 antibody-associated autoimmune encephalitis: a case report

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年5月20日

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  • Nurhak Demi̇r,
  • Şahin Işık,
  • Özlem Önder

摘要

Leucine-rich glioma-inactivated 1 (LGI1) antibody–associated encephalitis typically presents with focal seizures, memory impairment, psychiatric symptoms, and hyponatremia. Sleep disturbances—such as insomnia, hypersomnia, and rapid eye movement (REM) sleep behavior disorder—are increasingly recognized within its clinical spectrum. Oneiric stupor, characterized by stereotyped gestures mimicking everyday activities, is a core manifestation of agrypnia excitata but has only rarely been reported in association with LGI1 encephalitis.

We report a previously healthy 78-year-old man who presented with prominent sleep disturbances following epileptic seizures, insomnia, and psychiatric symptoms. After an initial period of drowsiness and confusion, his clinical course rapidly evolved to fluctuating sleep–wake–like states accompanied by involuntary simple and complex behaviors resembling daily life activities, consistent with oneiric stupor. Anti-LGI1 antibodies were detected in both cerebrospinal fluid and serum. Following immunotherapy, neuropsychiatric symptoms, including oneiric stupor, resolved completely.

This case demonstrates that oneiric stupor, although a rare manifestation, may predominate the clinical presentation in the advanced stage of LGI1 antibody–associated encephalitis. This distinctive clinical finding may aid in raising diagnostic suspicion and is reversible following treatment initiation.