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Anti-GAD65 Encephalitis: A Cryptic Case Requiring a Multidisciplinary Approach.

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Summary
This summary is machine-generated.

Autoimmune encephalitis, specifically anti-glutamic acid decarboxylase 65 (GAD65) antibody encephalitis, can present as catatonia. Electroconvulsive therapy (ECT) offers an effective treatment option for refractory cases, even after immunotherapy.

Keywords:
autoimmune encephalitiscatatoniaelectroconvulsive therapyneuropsychiatry

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Area of Science:

  • Neuroimmunology
  • Neurology
  • Psychiatry

Background:

  • Anti-glutamic acid decarboxylase 65 (GAD65) antibody encephalitis presents diagnostic challenges due to varied neuropsychiatric symptoms mimicking psychiatric disorders.
  • The condition's spectrum includes limbic dysfunction and catatonia, necessitating integrated treatment approaches.

Purpose of the Study:

  • To highlight the diagnostic and therapeutic considerations for anti-GAD65 antibody encephalitis presenting as catatonia.
  • To illustrate the role of electroconvulsive therapy (ECT) in managing refractory autoimmune encephalitis.

Main Methods:

  • Case presentation of a 78-year-old woman with acute-onset catatonia and visual hallucinations.
  • Neurological evaluation including antibody testing, neuroimaging, and electroencephalography.
  • Treatment with lorazepam, intravenous immunoglobulin, and subsequently electroconvulsive therapy (ECT).

Main Results:

  • Elevated anti-GAD65 antibodies were detected, with unremarkable neuroimaging and electroencephalography.
  • Partial response to initial immunotherapy (lorazepam, IVIg) was observed.
  • Electroconvulsive therapy (ECT) led to sustained remission of catatonia and psychosis.

Conclusions:

  • Late-onset catatonia warrants evaluation for autoimmune etiologies, including anti-GAD65 antibodies.
  • Partial immunotherapy response does not exclude the need for aggressive symptomatic management.
  • Electroconvulsive therapy (ECT) is effective for catatonia secondary to autoimmune encephalitis, emphasizing multidisciplinary care.