Autoimmune GFAP Astrocytopathy-Beyond the Known Horizon, India's First Multifaceted Institutional Experience.

Area of Science:

• Neurology
• Immunology
• Neuroinflammation

Background:

• Autoimmune glial fibrillary acidic protein (GFAP) astrocytopathy is an immune-mediated central nervous system disorder.
• It presents with a wide range of neurological symptoms including meningoencephalitis, myelitis, and seizures.
• Limited literature and no Indian case series exist for this condition.

Purpose of the Study:

• To describe the varied clinical presentations of anti-GFAP astrocytopathy.
• To review the existing literature on autoimmune GFAP astrocytopathy.
• To report the first case series from India.

Main Methods:

• Retrospective study of patients testing positive for GFAP immunoglobulin G in CSF and/or serum.
• Data collected from February 2023 to August 2023.
• Descriptive analysis of clinical and demographic data, with literature review.

Main Results:

• Four patients (3 female:1 male, median age 28) were included.
• Clinical spectrum included ataxia, seizures, myelitis, and autonomic dysfunction.
• All patients responded well to steroids; two received rituximab.

Conclusions:

• Autoimmune GFAP astrocytopathy has an expanding clinical spectrum and should be considered in various neurological disorders.
• The first Indian case series shows a favorable clinical profile.
• Diagnostic challenges highlight the need for a predictive diagnostic algorithm.