Meningoencephalitis associated with GAD65 autoimmunity
BackgroundEncephalitis has been recognized in patients with autoimmunity related to the 65-kDa isoform of glutamic acid decarboxylase (GAD65) antibodies; however, patients with meningoencephalitis associated with those antibodies have been rarely identified in the medical literature. We aimed to def...
| Main Authors: | , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Frontiers Media S.A.
2023-03-01
|
| Series: | Frontiers in Immunology |
| Subjects: | |
| Online Access: | https://www.frontiersin.org/articles/10.3389/fimmu.2023.1120894/full |
| _version_ | 1811155635900776448 |
|---|---|
| author | Zuying Kuang José Fidel Baizabal-Carvallo José Fidel Baizabal-Carvallo Mohammad Mofatteh Sifen Xie Mengqiu Pan Jinlong Ye Lihua Zhou Shuiquang Yang Zhanhang Wang Yimin Chen Yaqin Li |
| author_facet | Zuying Kuang José Fidel Baizabal-Carvallo José Fidel Baizabal-Carvallo Mohammad Mofatteh Sifen Xie Mengqiu Pan Jinlong Ye Lihua Zhou Shuiquang Yang Zhanhang Wang Yimin Chen Yaqin Li |
| author_sort | Zuying Kuang |
| collection | DOAJ |
| description | BackgroundEncephalitis has been recognized in patients with autoimmunity related to the 65-kDa isoform of glutamic acid decarboxylase (GAD65) antibodies; however, patients with meningoencephalitis associated with those antibodies have been rarely identified in the medical literature. We aimed to define the frequency, clinical features, response to therapy, and functional outcomes of patients with meningoencephalitis associated with GAD antibodies.MethodsWe retrospectively studied consecutive patients attending a tertiary care center for evaluation of an autoimmune neurological disorder from January 2018 to June 2022. The modified Rankin Scale (mRS) was used to assess the functional outcome at the last follow-up.ResultsWe evaluated 482 patients with confirmed autoimmune encephalitis during the study period. Four among the 25 patients with encephalitis related to GAD65 antibodies were identified. One patient was excluded owing to the coexistence of NMDAR antibodies. Three male patients aged 36, 24, and 16 years had an acute (n = 1) or subacute (n = 2) onset of confusion, psychosis, cognitive symptoms, seizures, or tremor. No patient had fever or clinical signs of meningeal irritation. Mild pleocytosis (<100 leukocytes/106) was identified in two patients, whereas one patient had normal CSF. Following immunotherapy with corticosteroids (n = 3) or intravenous immunoglobulin (n = 1), significant improvement was observed in all three cases, achieving a good outcome (mRS 1) in all cases.ConclusionMeningoencephalitis is an uncommon presentation of GAD65 autoimmunity. Patients present with signs of encephalitis but with meningeal enhancement and have good outcomes. |
| first_indexed | 2024-04-10T04:37:50Z |
| format | Article |
| id | doaj.art-bb2046d26560482bb6071693cb617a6d |
| institution | Directory Open Access Journal |
| issn | 1664-3224 |
| language | English |
| last_indexed | 2024-04-10T04:37:50Z |
| publishDate | 2023-03-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Immunology |
| spelling | doaj.art-bb2046d26560482bb6071693cb617a6d2023-03-09T15:45:11ZengFrontiers Media S.A.Frontiers in Immunology1664-32242023-03-011410.3389/fimmu.2023.11208941120894Meningoencephalitis associated with GAD65 autoimmunityZuying Kuang0José Fidel Baizabal-Carvallo1José Fidel Baizabal-Carvallo2Mohammad Mofatteh3Sifen Xie4Mengqiu Pan5Jinlong Ye6Lihua Zhou7Shuiquang Yang8Zhanhang Wang9Yimin Chen10Yaqin Li11Department of Neurology, GuangDong 999 Brain Hospital, Guangzhou, ChinaParkinson’s Disease Center and Movement Disorders Clinic, Department of Neurology, Baylor College of Medicine, Houston, TX, United StatesDepartment of Sciences and Engineering, University of Guanajuato, León, MexicoSchool of Medicine, Dentistry and Biomedical Sciences, Queen’s University Belfast, Belfast, United KingdomDepartment of Neurology, GuangDong 999 Brain Hospital, Guangzhou, ChinaDepartment of Neurology, GuangDong 999 Brain Hospital, Guangzhou, ChinaDepartment of Neurology, GuangDong 999 Brain Hospital, Guangzhou, ChinaDepartment of Neurology, GuangDong 999 Brain Hospital, Guangzhou, ChinaDepartment of Neurology, Foshan Sanshui District People’s Hospital, Foshan, Guangdong, ChinaDepartment of Neurology, GuangDong 999 Brain Hospital, Guangzhou, ChinaDepartment of Neurology, Foshan Sanshui District People’s Hospital, Foshan, Guangdong, ChinaDepartment of Neurology, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, Guangdong, ChinaBackgroundEncephalitis has been recognized in patients with autoimmunity related to the 65-kDa isoform of glutamic acid decarboxylase (GAD65) antibodies; however, patients with meningoencephalitis associated with those antibodies have been rarely identified in the medical literature. We aimed to define the frequency, clinical features, response to therapy, and functional outcomes of patients with meningoencephalitis associated with GAD antibodies.MethodsWe retrospectively studied consecutive patients attending a tertiary care center for evaluation of an autoimmune neurological disorder from January 2018 to June 2022. The modified Rankin Scale (mRS) was used to assess the functional outcome at the last follow-up.ResultsWe evaluated 482 patients with confirmed autoimmune encephalitis during the study period. Four among the 25 patients with encephalitis related to GAD65 antibodies were identified. One patient was excluded owing to the coexistence of NMDAR antibodies. Three male patients aged 36, 24, and 16 years had an acute (n = 1) or subacute (n = 2) onset of confusion, psychosis, cognitive symptoms, seizures, or tremor. No patient had fever or clinical signs of meningeal irritation. Mild pleocytosis (<100 leukocytes/106) was identified in two patients, whereas one patient had normal CSF. Following immunotherapy with corticosteroids (n = 3) or intravenous immunoglobulin (n = 1), significant improvement was observed in all three cases, achieving a good outcome (mRS 1) in all cases.ConclusionMeningoencephalitis is an uncommon presentation of GAD65 autoimmunity. Patients present with signs of encephalitis but with meningeal enhancement and have good outcomes.https://www.frontiersin.org/articles/10.3389/fimmu.2023.1120894/fullanti-glutamic acid decarboxylaseantibodiesencephalitisautoimmunityGAD65meningoencephalitis |
| spellingShingle | Zuying Kuang José Fidel Baizabal-Carvallo José Fidel Baizabal-Carvallo Mohammad Mofatteh Sifen Xie Mengqiu Pan Jinlong Ye Lihua Zhou Shuiquang Yang Zhanhang Wang Yimin Chen Yaqin Li Meningoencephalitis associated with GAD65 autoimmunity Frontiers in Immunology anti-glutamic acid decarboxylase antibodies encephalitis autoimmunity GAD65 meningoencephalitis |
| title | Meningoencephalitis associated with GAD65 autoimmunity |
| title_full | Meningoencephalitis associated with GAD65 autoimmunity |
| title_fullStr | Meningoencephalitis associated with GAD65 autoimmunity |
| title_full_unstemmed | Meningoencephalitis associated with GAD65 autoimmunity |
| title_short | Meningoencephalitis associated with GAD65 autoimmunity |
| title_sort | meningoencephalitis associated with gad65 autoimmunity |
| topic | anti-glutamic acid decarboxylase antibodies encephalitis autoimmunity GAD65 meningoencephalitis |
| url | https://www.frontiersin.org/articles/10.3389/fimmu.2023.1120894/full |
| work_keys_str_mv | AT zuyingkuang meningoencephalitisassociatedwithgad65autoimmunity AT josefidelbaizabalcarvallo meningoencephalitisassociatedwithgad65autoimmunity AT josefidelbaizabalcarvallo meningoencephalitisassociatedwithgad65autoimmunity AT mohammadmofatteh meningoencephalitisassociatedwithgad65autoimmunity AT sifenxie meningoencephalitisassociatedwithgad65autoimmunity AT mengqiupan meningoencephalitisassociatedwithgad65autoimmunity AT jinlongye meningoencephalitisassociatedwithgad65autoimmunity AT lihuazhou meningoencephalitisassociatedwithgad65autoimmunity AT shuiquangyang meningoencephalitisassociatedwithgad65autoimmunity AT zhanhangwang meningoencephalitisassociatedwithgad65autoimmunity AT yiminchen meningoencephalitisassociatedwithgad65autoimmunity AT yaqinli meningoencephalitisassociatedwithgad65autoimmunity |