Thane : For nearly three months, a 35-year-old woman battled recurrent convulsions and unexplained neurological symptoms. She had consulted multiple hospitals, was undergoing treatment for seizures and had even been started on antidepressants as part of her evaluation. Despite several investigations, the cause of her worsening condition remained unclear. It was only after she developed another episode during a scheduled MRI scan at KIMS Hospitals, Thane, that doctors identified the real culprit—a rare neurological condition called autoimmune encephalitis, in which the body’s immune system mistakenly attacks the brain.
The patient was immediately evaluated by Dr. Dipesh Pimple, Consultant Neurologist, KIMS Hospitals, Thane, after she developed severe convulsions during a scheduled 3-Tesla MRI. She had been experiencing recurrent seizure-like episodes for nearly three months and had undergone neurological evaluation elsewhere, including a normal video EEG and a PET scan that demonstrated hypometabolism. She had also been assessed by Dr. Siddharth Kharkar, Consultant Neurologist, who also suspected an autoimmune neurological disorder and advised to continue immunotherapy.
Her sudden deterioration during imaging further reinforced concerns that the condition was not following the course of a typical seizure disorder.
Despite medications, the abnormal movements continued and did not resemble conventional epileptic seizures. As her condition worsened, she required emergency intubation, ventilatory support and multiple anti-epileptic medications while the neurology and critical care team led by Dr Amit R, Dr Yogendra, Dr Paulomi worked rapidly to identify the underlying cause.
What made the case particularly challenging was that both routine EEG and prolonged EEG monitoring remained normal despite the persistent seizure-like episodes. Based on the atypical seizure pattern, behavioural symptoms, normal EEG findings and the overall clinical picture, Dr. Dipesh Pimple strongly suspected autoimmune encephalitis on the very first day of admission—a rare neurological disorder that often mimics epilepsy or psychiatric illness, frequently delaying diagnosis and treatment.
Without waiting for further deterioration, high-dose intravenous methylprednisolone was initiated after detailed counselling with the patient’s family. Simultaneously, additional investigations, including a whole-body PET-MRI, were performed to rule out an underlying malignancy, as certain forms of autoimmune encephalitis can be associated with hidden cancers. A high-resolution 3-Tesla MRI also demonstrated volume loss in the left temporal lobe, further supporting the diagnosis.
Although the frequency of abnormal movements reduced, occasional episodes persisted over the next few days. After discussing advanced treatment options with the family, the team initiated intravenous immunoglobulin (IVIG) therapy.
The response was remarkable. By the second day of immunoglobulin therapy, the patient’s abnormal movements had reduced significantly. She was gradually weaned off ventilatory support over the following few days and shifted out of the Intensive Care Unit. With structured neurological rehabilitation, she regained her strength, began walking independently, resumed eating without assistance and gradually returned to her daily activities. At follow-up, she continued to show sustained improvement with only occasional residual episodes.
Speaking about the case, Dr. Dipesh Pimple, Consultant Neurologist, KIMS Hospitals, Thane, said:
“Autoimmune encephalitis is one of the most challenging neurological conditions because it can closely resemble epilepsy or even primary psychiatric illness in its early stages. In this patient, the seizure pattern, normal EEG findings and behavioural symptoms did not fit the usual picture. Rather than waiting for every investigation to confirm the diagnosis, we relied on careful clinical assessment and initiated immunotherapy early. Timely treatment played a crucial role in controlling the disease and significantly improving her recovery.”
The patient’s recovery was made possible through a coordinated multidisciplinary effort involving neurology, critical care, radiology, psychiatry, rehabilitation specialists, nursing teams and allied healthcare professionals. The case also highlights the importance of early clinical suspicion and seamless collaboration between neurologists, ensuring that patients with uncommon neurological disorders receive timely diagnosis and life-saving treatment.
Autoimmune encephalitis is a rare but potentially treatable neurological disorder in which the immune system attacks healthy brain tissue. It may present with seizures, memory problems, confusion, behavioural changes or psychiatric symptoms, making early diagnosis particularly challenging. Experts emphasise that patients with unexplained seizure-like episodes that do not respond as expected should undergo timely neurological evaluation, as early recognition and immunotherapy can significantly improve outcomes.
This case underscores the importance of clinical judgement alongside investigations. By recognising an uncommon diagnosis early and initiating treatment without delay, the treating team was able to alter the course of a potentially devastating neurological illness and help a young woman return to an independent life.