GAD65 antibody-associated autoimmune epilepsy with unique independent bitemporal-onset ictal asystole

Epileptic Disord. 2018 Jun 1;20(3):204-208. doi: 10.1684/epd.2018.0971.

Abstract

Antibodies against the 65-kDa isoform of the intracellular enzyme, glutamate decarboxylase (GAD65), have been found in patients with limbic encephalitis and drug-resistant autoimmune epilepsy. We report a 22-year-old female who presented with new-onset seizures and neuropsychiatric symptoms. Video-EEG captured unique, independent bitemporal-onset focal seizures with impaired awareness and ictal asystole. An autoimmune epilepsy panel revealed elevated GAD65 antibodies in the serum (225 nmol/l) and CSF (2.78 nmol/l), while [18F]-fluoro-deoxy-glucose positron emission tomography showed bitemporal hypometabolism (left > right). The patient was diagnosed with GAD65 antibody-associated autoimmune epilepsy. Our observation adds to the spectrum of neurocardiac syndromes associated with autoimmune epilepsy.

Keywords: GAD65; asystole; autoimmune epilepsy; focal epilepsy; limbic encephalitis; neurocardiac syndromes.

Publication types

  • Case Reports

MeSH terms

  • Autoantibodies
  • Electroencephalography
  • Epilepsy / immunology*
  • Epilepsy / physiopathology
  • Female
  • Glutamate Decarboxylase / immunology*
  • Humans
  • Limbic Encephalitis / immunology*
  • Limbic Encephalitis / physiopathology
  • Young Adult

Substances

  • Autoantibodies
  • Glutamate Decarboxylase
  • glutamate decarboxylase 2