John Libbey Eurotext

GAD65 antibody-associated autoimmune epilepsy with unique independent bitemporal-onset ictal asystole Volume 20, issue 3, June 2018


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Department of Neurology, Mayo Clinic, Jacksonville, FL, USA
* Correspondence: Caitlin E. D'Souza Department of Neurology, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL 32224, USA
  • Key words: asystole, autoimmune epilepsy, GAD65, focal epilepsy, limbic encephalitis, neurocardiac syndromes
  • DOI : 10.1684/epd.2018.0971
  • Page(s) : 204-8
  • Published in: 2018

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.