title: Type 1 diabetes mellitus and drug-resistant epilepsy: presence of high titer of anti-glutamic acid decarboxylase autoantibodies in serum and cerebrospinal fluid.
abstract: A 55-year-old man who was diagnosed as having type 1 diabetes mellitus (DM) at the age of 50 years was started on insulin therapy. At 54 years old of age, he suddenly developed complex partial seizures, which frequently occurred despite intensive anti-epileptic drug therapy. Neurological examination on admission revealed hyporeflexia in bilateral upper and lower extremities without any muscle rigidity, painful spasm or cerebellar ataxia. Laboratory examination showed poor glycemic control with increased glycated hemoglobin levels. Positive anti-thyroglobulin antibodies and anti-thyroid peroxidase (TPO) antibodies and slight elevation of TSH levels are consistent with subclinical hypothyroidism due to Hashimoto's thyroiditis. A high titer of anti-glutamic acid decarboxylase (GAD) antibodies was detected in the patient's serum and cerebrospinal fluid (CSF). Electroencephalography showed temporal spikes, consistent with complex partial seizure. This is a very rare case presenting with concomitant type 1 diabetes and drug-resistant epilepsy associated with high titers of circulating and CSF anti-GAD antibodies.
authors.affiliation: Department of Clinical and Molecular Endocrinology, Tokyo Medical and Dental University, Graduate School, Tokyo.
authors.forename: Takanobu
authors.initials: T
authors.lastname: Yoshimoto
authors.forename: Masaru
authors.initials: M
authors.lastname: Doi
authors.forename: Nozomi
authors.initials: N
authors.lastname: Fukai
authors.forename: Hajime
authors.initials: H
authors.lastname: Izumiyama
authors.forename: Takehiko
authors.initials: T
authors.lastname: Wago
authors.forename: Isao
authors.initials: I
authors.lastname: Minami
authors.forename: Isao
authors.initials: I
authors.lastname: Uchimura
authors.forename: Yukio
authors.initials: Y
authors.lastname: Hirata
mesh_terms: D000927:Anticonvulsants / Q000009:adverse effects*; D001323:Autoantibodies / Q000097:blood* / Q000134:cerebrospinal fluid*; D003922:Diabetes Mellitus, Type 1 / Q000150:complications / Q000276:immunology* / Q000378:metabolism; D004351:Drug Resistance; D017029:Epilepsy, Complex Partial / Q000150:complications / Q000188:drug therapy / Q000276:immunology*; D005500:Follow-Up Studies; D005968:Glutamate Decarboxylase / Q000276:immunology*; D006801:Humans; D008297:Male; D008875:Middle Aged
chemical_list: D000927:Anticonvulsants; D001323:Autoantibodies; D005968:Glutamate Decarboxylase