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GAD65 Antibody-Associated Epilepsy

Autoimmune processes are an increasingly recognized cause of seizures. Antibodies against neuronal surface antigens are implicated in the development of acute symptomatic seizures secondary to autoimmune encephalitis, whereas antibodies against intracellular antigens (anti-glutamic acid decarboxylas...

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Autores principales: Valinčiūtė, Justina, Jucevičiūtė, Neringa, Balnytė, Renata, Jurkevičienė, Giedrė, Gelžinienė, Giedrė
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10305176/
https://www.ncbi.nlm.nih.gov/pubmed/37374339
http://dx.doi.org/10.3390/medicina59061135
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author Valinčiūtė, Justina
Jucevičiūtė, Neringa
Balnytė, Renata
Jurkevičienė, Giedrė
Gelžinienė, Giedrė
author_facet Valinčiūtė, Justina
Jucevičiūtė, Neringa
Balnytė, Renata
Jurkevičienė, Giedrė
Gelžinienė, Giedrė
author_sort Valinčiūtė, Justina
collection PubMed
description Autoimmune processes are an increasingly recognized cause of seizures. Antibodies against neuronal surface antigens are implicated in the development of acute symptomatic seizures secondary to autoimmune encephalitis, whereas antibodies against intracellular antigens (anti-glutamic acid decarboxylase (GAD) and onconeural antibodies) are found in cases of autoimmune-associated epilepsy (AAE). AAE is described as isolated drug-resistant epilepsy without any specific magnetic resonance imaging (MRI) or cerebrospinal fluid changes and with a very limited response to immunotherapy. We present a clinical case and a literature review on autoimmune-associated epilepsy to increase awareness of this disease and illustrate its complexity. This is a clinical case of a female with a history of refractory focal epilepsy. The patient had been given several trials of multiple antiepileptic drugs and their combinations without any clear effect. Multiple evaluations including brain MRI, PET, and interictal and ictal electroencephalograms were performed. An APE2 score was calculated with a result of 4 and, in the presence of anti-GAD65 antibodies in the serum, the diagnosis of AAE was confirmed. There was no effect after five sessions of plasma exchange; however, after a course of intravenous immunoglobulin, a positive but temporary clinical effect was noticed: anti-GAD65 levels initially decreased but rebounded to previous levels 6 months later.
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spelling pubmed-103051762023-06-29 GAD65 Antibody-Associated Epilepsy Valinčiūtė, Justina Jucevičiūtė, Neringa Balnytė, Renata Jurkevičienė, Giedrė Gelžinienė, Giedrė Medicina (Kaunas) Case Report Autoimmune processes are an increasingly recognized cause of seizures. Antibodies against neuronal surface antigens are implicated in the development of acute symptomatic seizures secondary to autoimmune encephalitis, whereas antibodies against intracellular antigens (anti-glutamic acid decarboxylase (GAD) and onconeural antibodies) are found in cases of autoimmune-associated epilepsy (AAE). AAE is described as isolated drug-resistant epilepsy without any specific magnetic resonance imaging (MRI) or cerebrospinal fluid changes and with a very limited response to immunotherapy. We present a clinical case and a literature review on autoimmune-associated epilepsy to increase awareness of this disease and illustrate its complexity. This is a clinical case of a female with a history of refractory focal epilepsy. The patient had been given several trials of multiple antiepileptic drugs and their combinations without any clear effect. Multiple evaluations including brain MRI, PET, and interictal and ictal electroencephalograms were performed. An APE2 score was calculated with a result of 4 and, in the presence of anti-GAD65 antibodies in the serum, the diagnosis of AAE was confirmed. There was no effect after five sessions of plasma exchange; however, after a course of intravenous immunoglobulin, a positive but temporary clinical effect was noticed: anti-GAD65 levels initially decreased but rebounded to previous levels 6 months later. MDPI 2023-06-12 /pmc/articles/PMC10305176/ /pubmed/37374339 http://dx.doi.org/10.3390/medicina59061135 Text en © 2023 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Case Report
Valinčiūtė, Justina
Jucevičiūtė, Neringa
Balnytė, Renata
Jurkevičienė, Giedrė
Gelžinienė, Giedrė
GAD65 Antibody-Associated Epilepsy
title GAD65 Antibody-Associated Epilepsy
title_full GAD65 Antibody-Associated Epilepsy
title_fullStr GAD65 Antibody-Associated Epilepsy
title_full_unstemmed GAD65 Antibody-Associated Epilepsy
title_short GAD65 Antibody-Associated Epilepsy
title_sort gad65 antibody-associated epilepsy
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10305176/
https://www.ncbi.nlm.nih.gov/pubmed/37374339
http://dx.doi.org/10.3390/medicina59061135
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