Anti–glutamic acid decarboxylase directed antibodies are a rare cause of autoimmune limbic encephalitis that is relatively resistant to immunotherapy. Here we report a 15-year-old boy with nonparaneoplastic, anti–glutamic acid decarboxylase limbic encephalitis presenting with subacute headache, memory disturbance, psychiatric symptoms, and seizures. At onset, his memory disturbance manifested as transient global amnesia-like episodes. Clinical remission was achieved with rituximab, intravenous immunoglobulin, and corticosteroids.
SaizABlancoYSabaterL. Spectrum of neurological syndromes associated with glutamic acid decarboxylase antibodies: diagnostic clues for this association. Brain. 2008;131:2553–2563.
2.
MalterMPHelmstaedterCUrbachH. Antibodies to glutamic acid decarboxylase define a form of limbic encephalitis. Ann Neurol. 2010;67:470–478.
3.
BlancFRuppertEKleitzC. Acute limbic encephalitis and glutamic acid decarboxylase antibodies: a reality?J Neurol Sci. 2009;287:69–71.
4.
MazziGRoiaDDCruciattiB. Plasma exchange for anti GAD associated non-paraneoplastic limbic encephalitis. Transfus Apher Sci. 2008;39:229–233.
PittockSJYoshikawaHJAhlskogE. Glutamic acid decarboxylase autoimmunity with brainstem, extrapyramidal, and spinal cord dysfunction. Mayo Clin Proc. 2006;81:1207–1214.
7.
AkmanCIPattersonMCRubinsteinAHerzogR. Limbic encephalitis associated with anti-GAD antibody and common variable immune deficiency. Dev Med Child Neurol. 2009;51:563–567.
8.
KorffCMParvexPCimasoniL. Encephalitis associated with glutamic acid decarboxylase autoantibodies in a child. Arch Neurol. 2011;68:1065–1068.
9.
OlsonJAOlsonDMSandborgC. Type 1 diabetes mellitus and epilepsia partialis continua in a 6-year-old boy with elevated anti-GAD65 antibodies. Pediatrics. 2002;109:e50.
10.
LiimatainenSPeltolaMSabaterL. Clinical significance of glutamic acid decarboxylase antibodies in patients with epilepsy. Epilepsia. 2009;51:760–767.
11.
KanterICHuttnerHBStaykovD. Cyclophosphamide for anti-GAD antibody-positive refractory status epilepticus. Epilepsia. 2008;49:914–20.
12.
McHughJCMurrayBRenganathanR. GAD antibody positive paraneoplastic stiff person syndrome in a patient with renal cell carcinoma. Mov Disord. 2007;22:1343–1346.
13.
MantoMULauteMAAgueraM. Effects of anti-glutamic acid decarboxylase antibodies associated with neurological diseases. Ann Neurol. 2007;61:544–551.
14.
SloviterRSDichterMARachinskyTL. Basal expression and induction of glutamate decarboxylase and GABA in excitatory granule cells of the rat and monkey hippocampal dentate gyrus. J Comp Neurol. 1996;373:593–618.
15.
ChristgauSAanstootHJSchierbeckH. Membrane anchoring of the autoantigen GAD65 to microvesicles in pancreatic beta-cells by palmitoylation in the NH2-terminal domain. J Cell Biol. 1992;118:309–320.
16.
DinkelKMeinckHMJuryKM. Inhibition of gamma-aminobutyric acid synthesis by glutamic acid decarboxylase autoantibodies in stiff-man syndrome. Ann Neurol. 1998;44:194–201.
17.
WarrenJDScottGBlumbergsPCThompsonPD. Pathological evidence of encephalomyelitis in the stiff man syndrome with anti-GAD antibodies. J Clin Neurosci. 2002;9:328–329.
18.
TosiLRighettiCA. Transient global amnesia and migraine in young people. Clin Neurol Neurosurg. 1997;99:63–65.
19.
StruppMBruningRWuRH. Diffusion-weighted MRI in transient global amnesia: elevated signal intensity in the left mesial temporal lobe in 7 of 10 patients. Ann Neurol. 1998;43:164–170.
20.
NakadaTKweeILFujiiYKnightRT. High-field, T2 reversed MRI of the hippocampus in transient global amnesia. Neurology. 2005;64:1170–1174.
21.
DalakasMCFujiiMLiM. High-dose intravenous immune globulin for stiff-person syndrome. N Engl J Med. 2001;345:1870–1876.
22.
SaidhaSMurphySRonayneA. Treatment of anti-glutamic acid decarboxylase antibody-associated limbic encephalitis with mycophenolate mofetil. J Neurol. 2010;257:1035–1038.
