title: Cerebellar ataxia and epilepsy with anti-GAD antibodies: treatment with IVIG and plasmapheresis.
abstract: Glutamic acid decarboxylase autoantibody (GAD-65) catalyses glutamate conversion into γ-aminobutyric acid (GABA) in the central nervous system and in the pancreatic β cells. Antibodies targeting GAD-65 are of uncertain pathogenic significance and occur in stiff person syndrome, cerebellar ataxia, epilepsy, limbic encephalitis and combinations thereof and diabetes mellitus. A 45-year-old man with a cerebellar gait ataxia, dysmetria, nystagmus and mild cerebellar dysarthria was diagnosed with insulin-dependent diabetes mellitus a year after the onset of neurological symptoms. He also developed complex and tonic-clonic seizures, resistant to anticonvulsant medication and deteriorated cognitively. Blood and cerebrospinal fluid serology, and imaging supported the diagnosis of GAD-65 cerebellar ataxia and epilepsy. He was treated with intravenous immunoglobulin and subsequently plasmapheresis. We report the outcome of 3 years of treatment, which resulted in the improvement of cerebellar signs (particularly gait), with some ultimate decline of efficacy.
authors.affiliation: Queen Elizabeth Hospital King's Lynn, King's Lynn, UK.
authors.forename: Zoya
authors.initials: Z
authors.lastname: Georgieva
authors.forename: Matthew
authors.initials: M
authors.lastname: Parton
mesh_terms: D001323:Autoantibodies / Q000097:blood; D002524:Cerebellar Ataxia / Q000150:complications / Q000276:immunology* / Q000628:therapy; D004827:Epilepsy / Q000150:complications / Q000276:immunology* / Q000628:therapy; D005684:Gait; D005968:Glutamate Decarboxylase / Q000276:immunology*; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D010956:Plasmapheresis
chemical_list: D001323:Autoantibodies; D016756:Immunoglobulins, Intravenous; D005968:Glutamate Decarboxylase