Dacrystic seizures—a cry for help

A 69-year-old man with a history of myocardial infarction presented with crying-like spells. MRI demonstrated abnormal signal in the left mesiotemporal lobe, and he was diagnosed with stroke. Over the following 1 year, he developed progressive cognitive decline, slow gait, masked facies, hypophonic voice, and brief facial and upper extremity spasms (8 per hour) often followed by brief crying spells lacking emotion. Spell semiology was consistent with faciobrachial dystonic seizures and dacrystic seizures (video at Neurology.org/nn). Leucine-rich glioma-inactivated-1 (LGI1) autoantibodies, detected in serum, led to a diagnosis of anti-LGI1 encephalitis. This is the first report of dacrystic seizures accompanying anti-LGI1 encephalitis.