Non-Convulsive Status Epilepticus Associated With Glutamic Acid Decarboxylase Antibody

Çıkrıkçılı, Uğur; Ulusoy, Canan; Turan, Selin; Yıldız, Şenay; Bılgıç, Başar; Hanağası, Haşmet; Baykan, Betül; Tüzün, Erdem; Gürvit, Hakan

doi:10.1177/1550059412459330

Cited by 17 publications

(10 citation statements)

References 16 publications

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“…Three patients had histologically confirmed cancer diagnosis, as seen in Table 1. Patient 6 with NCSE was previously reported by Cikrikcili et al 17 Full details of the remaining 13 seropositive patients who were diagnosed with chronic epilepsy associated with neuronal Ab were given in a previous report. 7 Psychiatric disorders depression and psychotic spells were associated with 11 (52%) of the seropositive group.…”

Section: Discussionmentioning

confidence: 99%

Are There Any Specific EEG Findings in Autoimmune Epilepsies?

et al. 2015

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This study evaluated the EEG findings of patients whose seizures were associated with a possible autoimmune etiology. Our aim was to find clues to distinguish patients with antineuronal antibodies (Ab) through EEG studies. We reviewed our database and identified antineuronal Ab positive epilepsy patients with or without autoimmune encephalitis. These patients had Abs to N-methyl-d-aspartate receptor (NMDAR) (n = 5), glycine receptor (GLY-R) (n = 5), contactin-associated protein-like 2 (CASPR-2) (n = 4), uncharacterized voltage-gated potassium channel complex (VGKC) antigens (n = 2), glutamic acid decarboxylase (GAD) (n = 2), Hu (n = 1), and amphiphysin (n = 1). The control group consisted of 21 seronegative epilepsy or encephalopathy patients with similar clinical features. EEG findings were compared between the groups in a blindfolded design. We did not find any significant difference in EEG findings between antineuronal Ab positive epilepsy patients and seronegative control group. It was remarkable that four seropositive but none of the seronegative patients presented with nonconvulsive status epilepticus (NCSE) or focal motor status epilepticus. Continuous theta and delta rhythms were observed in 5 (71%) seropositive patients with autoimmune encephalitis and 2 (25%) seronegative patients. Eight (40 %) seropositive patients showed a frontal intermittent rhythmic delta activity (FIRDA) pattern as opposed to 5 (24%) seronegative patients. Two patients with NMDAR Ab positivity showed rhythmic delta waves superimposed with beta frequency activity resembling "delta brush" pattern. EEG seems as a limited diagnostic tool in differentiating epilepsy and/or encephalopathy patients with a possible autoimmune etiology from those without. However, antineuronal Abs associated with encephalitis should be considered in the etiology of status epilepticus forms. A possible autoimmune etiology for seizures may be considered in the presence of continuous slow waves, FIRDA, and delta brush pattern in the EEG.

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Section: Discussionmentioning

confidence: 99%

Are There Any Specific EEG Findings in Autoimmune Epilepsies?

et al. 2015

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“…Many controversies arise around the management of autoimmune epilepsy. Lack of response to pulse steroids has been considered a major feature in anti-GAD antibody positive encephalitis according to some literature [14] . On the contrary, a cohort of 13 patients with anti-GAD antibody positive TLE compared the following therapies with each other: corticosteroids, apheresis, intravenous immunoglobulin, natalizumab, and epilepsy surgery.…”

Section: Discussionmentioning

confidence: 99%

Conjoint glutamic acid decarboxylase 65 and P/Q voltage gated calcium channel antibodies in autoimmune epilepsy: A case report

AlKhaja

Alkawi

Abu-Ata

et al. 2018

Epilepsy & Behavior Case Reports

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Numerous autoantibodies are implicated in the pathogenesis of autoimmune epilepsy. In the past decade, many case series reported the association of glutamic acid decarboxylase 65 (GAD 65) antibodies with epilepsy. Conjoint presence of GAD 65 antibodies with antinuclear, anti-thyroid, and anti-parietal cell antibodies has often been demonstrated. However, concomitant elevated levels of GAD 65 and P/Q voltage gated calcium channel (VGCC) antibodies is rare. We report a case of autoimmune epilepsy with conjoint GAD 65 and P/Q VGCC antibodies in the absence of malignancy. This report highlights a possible role of P/Q VGCC antibodies in the pathogenesis of autoimmune epilepsy.

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“…The presence of GAD antibodies is occasionally associated with status epilepticus. Cikrikçili et al44 reported a 63-year-old woman initially admitted with sleep problems and psychiatric manifestations. Generalized and rhythmical slow spike-wave activity over the posterior regions of both hemispheres was found on EEG, and the patient was diagnosed with non-convulsive status epilepticus.…”

Section: Non-paraneoplastic Limbic Encephalitis and Glutamic Acid Decmentioning

confidence: 99%

“…According to Cikrikçili et al,44 GAD antibodies should be included in the list of anti-neuronal antibodies associated with non-convulsive status epilepticus. Furthermore, the disappearance of clinical manifestations after immunotherapy indicated that GAD antibodies could be involved in seizure neuro-pathogenesis 44. Besides LE, epilepsy can be seen in some other anti-GAD positive patients.…”

Section: Non-paraneoplastic Limbic Encephalitis and Glutamic Acid Decmentioning

confidence: 99%

Anti-glutamic acid decarboxylase antibody positive neurological syndromes

Tohid¹

2016

NSJ

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A rare kind of antibody, known as anti-glutamic acid decarboxylase (GAD) autoantibody, is found in some patients. The antibody works against the GAD enzyme, which is essential in the formation of gamma aminobutyric acid (GABA), an inhibitory neurotransmitter found in the brain. Patients found with this antibody present with motor and cognitive problems due to low levels or lack of GABA, because in the absence or low levels of GABA patients exhibit motor and cognitive symptoms. The anti-GAD antibody is found in some neurological syndromes, including stiff-person syndrome, paraneoplastic stiff-person syndrome, Miller Fisher syndrome (MFS), limbic encephalopathy, cerebellar ataxia, eye movement disorders, and epilepsy. Previously, excluding MFS, these conditions were called ‘hyperexcitability disorders’. However, collectively, these syndromes should be known as “anti-GAD positive neurological syndromes.” An important limitation of this study is that the literature is lacking on the subject, and why patients with the above mentioned neurological problems present with different symptoms has not been studied in detail. Therefore, it is recommended that more research is conducted on this subject to obtain a better and deeper understanding of these anti-GAD antibody induced neurological syndromes.

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Non-Convulsive Status Epilepticus Associated With Glutamic Acid Decarboxylase Antibody

Cited by 17 publications

References 16 publications

Are There Any Specific EEG Findings in Autoimmune Epilepsies?

Are There Any Specific EEG Findings in Autoimmune Epilepsies?

Conjoint glutamic acid decarboxylase 65 and P/Q voltage gated calcium channel antibodies in autoimmune epilepsy: A case report

Anti-glutamic acid decarboxylase antibody positive neurological syndromes

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