title: Epilepsy and behavioral changes, type 1 diabetes mellitus and a high titer of glutamic acid decarboxylase antibodies.
abstract: Autoantibodies to the 65 kDa isoform of glutamate acid decarboxylase (GAD65Ab) are associated with a range of clinical disorders, including type 1 diabetes (T1D) and stiff-person syndrome (SPS). In this article we describe a young girl who was diagnosed with T1D at the end of her first year of life and developed drug-resistant epilepsy 18 months later, followed by behavioral disturbances. She was admitted to our center at the age of 5 yr, at which time high GAD65Ab titers were detected in the patient's serum and cerebrospinal fluid (CSF). The titer remained elevated during 19 months of follow-up. Furthermore, GAD65Ab in both serum and CSF showed epitope binding characteristics similar to those observed for GAD65Ab in SPS patients, and GAD65Ab in the serum reduced GAD65 enzyme activity. Our results suggest an association between high GAD65Ab titers and epilepsy in children with T1D. Careful titration and characterization of GAD65Ab regarding inhibition of enzyme activity and epitope specificity may be helpful in identifying T1D patients at risk for neurological complications.
authors.affiliation: Pediatric Neurology Unit, The Edmond and Lily Safra Children's Hospital, Chaim Sheba Medical Center, Ramat-Gan, Israel. or_et@hotmail.com.|The Sackler School of Medicine, Tel Aviv University, Ramat Aviv, Israel. or_et@hotmail.com.
authors.forename: Esther
authors.initials: E
authors.lastname: Ganelin-Cohen
authors.affiliation: The Sackler School of Medicine, Tel Aviv University, Ramat Aviv, Israel.|Pediatric Endocrinology and Diabetes Unit, The Edmond and Lily Safra Children's Hospital, Chaim Sheba Medical Center, Ramat-Gan, Israel.
authors.forename: Dalit
authors.initials: D
authors.lastname: Modan-Moses
authors.affiliation: Institute of Endocrinology, Chaim Sheba Medical Center, Ramat-Gan, Israel.
authors.forename: Rina
authors.initials: R
authors.lastname: Hemi
authors.affiliation: Institute of Endocrinology, Chaim Sheba Medical Center, Ramat-Gan, Israel.
authors.forename: Hannah
authors.initials: H
authors.lastname: Kanety
authors.affiliation: Pediatric Neurology Unit, The Edmond and Lily Safra Children's Hospital, Chaim Sheba Medical Center, Ramat-Gan, Israel.|The Sackler School of Medicine, Tel Aviv University, Ramat Aviv, Israel.
authors.forename: Bruria
authors.initials: B
authors.lastname: Ben-Zeev
authors.affiliation: Department of Medicine, Division of Metabolism, Endocrinology and Nutrition, University of Washington, Seattle, WA, USA.
authors.forename: Christiane S
authors.initials: CS
authors.lastname: Hampe
mesh_terms: D001323:Autoantibodies / Q000097:blood*; D002653:Child Behavior Disorders / Q000097:blood / Q000209:etiology*; D002675:Child, Preschool; D003922:Diabetes Mellitus, Type 1 / Q000097:blood / Q000150:complications* / Q000276:immunology / Q000523:psychology; D003929:Diabetic Neuropathies / Q000097:blood / Q000276:immunology; D004827:Epilepsy / Q000097:blood / Q000209:etiology*; D005260:Female; D005968:Glutamate Decarboxylase / Q000276:immunology*; D006801:Humans
chemical_list: D001323:Autoantibodies; D005968:Glutamate Decarboxylase; C401141:glutamate decarboxylase 2
keywords: epilepsy; glutamate decarboxylase antibodies; immune-mediated; pediatric; type 1 diabetes