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Paraneoplastic anti-GAD65 extralimbic encephalitis presented with epilepsy: A case report
Si-Qi Xia1,2, Hao-Nan Fan3, Lin-Feng Fan1,2
1Department of Neurosurgery, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China.
Medicine
|November 7, 2023
Summary
Autoimmunity against glutamic acid decarboxylase 65 (GAD65) can cause rare extralimbic encephalitis (ELE), even with isolated epilepsy. This case highlights GAD65 ELE associated with small cell lung cancer.
Area of Science:
- Neuroimmunology
- Oncology
Background:
- Autoimmunity targeting glutamic acid decarboxylase 65 (GAD65) is linked to type 1 diabetes and neurological disorders.
- GAD65 autoimmunity typically manifests as limbic encephalitis, with extralimbic encephalitis (ELE) being rare.
Observation:
- A 60-year-old man with a history of small cell lung cancer presented with drug-resistant epilepsy.
- Magnetic resonance imaging revealed multifocal lesions in extralimbic brain regions.
- Analysis confirmed high GAD65 antibody levels and lymphocytic pleocytosis, indicative of autoimmune encephalitis.
Findings:
- The patient was diagnosed with anti-GAD65 autoimmune ELE with a paraneoplastic etiology.
- Despite treatment with antiepileptic drugs, the patient's epilepsy remained refractory.
Implications:
- This case demonstrates that anti-GAD65 autoimmune encephalitis can present with extralimbic involvement and isolated epilepsy.
- It underscores the potential for anti-GAD65 ELE to occur in the context of underlying malignancy, emphasizing the need for comprehensive paraneoplastic evaluation.
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