Predictive value of high titer of GAD65 antibodies in a case of limbic encephalitis

• Published in: Journal of neuroimmunology Vol. 337; p. 577063
• Main Authors: Di Giacomo, Roberta, Deleo, Francesco, Pastori, Chiara, Didato, Giuseppe, Andreetta, Francesca, Del Sole, Angelo, de Curtis, Marco, Villani, Flavio
• Format: Journal Article
• Language: English
• Published: Elsevier B.V 15.12.2019
• Subjects: Anti-glutamic acid decarboxylase 65 antibody; Autoimmune encephalitis; Immunotherapy; Limbic encephalitis; Neuroimmunology; Anti-glutamic acid decarboxylase 65 antibody; Immunotherapy; Limbic encephalitis; CSF; FDG; SMS; LE; Neuroimmunology; GAD65; Autoimmune encephalitis; ELISA
• ISSN: 0165-5728; 1872-8421
• DOI: 10.1016/j.jneuroim.2019.577063

We report the case of a 42-year-old woman who presented with vertigo and migraine and rapidly developed cognitive decline and seizures. Both serum and cerebro-spinal fluid samples showed high titer of anti-glutamic acid decarboxylase (anti-GAD65) antibodies (998,881 IU/ml and 54,687 IU/ml respectively). Limbic encephalitis was diagnosed and high dose steroids treatment started. During one-year follow-up, without further immunomodulatory therapy, the patient became seizure free, and cognitive functions returned to normal. Serum anti-GAD65 antibodies titer decreased significantly but remained elevated (192,680 IU/ml). We discuss the prognostic and pathogenic value of high titer anti-GAD65 antibodies and its variations in a case of autoimmune limbic encephalitis. [Display omitted] •Clinical spectrum of anti-GAD65 antibodies extended from asymptomatic to fulminant encephalitis.•Pathogenic link between the antibodies and limbic encephalitis appeared not clear•Antibodies titers may not be an indicator to guide long-term immunotherapy.•Narrow clinical and laboratory follow-up was relevant to therapeutic management.•Early treatment enabled good outcome in otherwise hard-to-treat condition.