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From the Departments of Neurology (Drs. Peltola, Palmio, and Keränen) and Pediatrics (Dr. Knip), Tampere University Hospital, Finland; the Departments of Neurology (Drs. Isojärvi and Latvala) and Pediatrics (Drs. Kulmala and Savola), Oulu University Hospital, Finland; and the Service of Neurology (Drs. Saiz and Graus), Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic, University of Barcelona, Spain.
Address correspondence and reprint requests to Dr. Jukka Peltola, Medical School, University of Tampere, FIN-33014 Finland; e-mail: lljupe{at}uta.fi
BACKGROUND: Autoantibodies to glutamic acid decarboxylase (GAD-A) are present in type 1 diabetes and stiff man syndrome (SMS), and have also been reported in cerebellar ataxia. Epilepsy was present in 4 of 19 patients with SMS and GAD-A, implying that epilepsy sometimes is associated with anti-GAD autoimmunity.
METHODS: The authors investigated the prevalence of GAD-A in patients with therapy-resistant localization-related epilepsy (n = 51) and generalized epilepsy (n = 49) by a radiobinding assay. The positive samples were confirmed by immunohistochemistry and immunoblotting of recombinant human GAD65.
RESULTS: GAD-A were found in eight patients with localization-related epilepsy, whereas none of the patients with generalized epilepsy, other neurologic disorders (n = 38), or the control subjects (n = 48) had GAD-A. Two patients had high levels of GAD-A, similar to SMS, whereas six patients had significantly lower titers, characteristic of type 1 diabetes. The two patients with high levels of GAD-A had GAD-A both in serum and CSF by immunohistochemistry and immunoblotting. Both of them had longstanding therapy-resistant temporal lobe epilepsy but did not have diabetes. One had a history of autoimmune disease, whereas the other had serologic evidence of multiple autoantibodies without any clinical signs of autoimmune disease.
CONCLUSIONS: GAD autoimmunity may be associated with refractory localization-related epilepsy.
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