Encephalitis associated with glutamic acid decarboxylase autoantibodies

Antiglutamic acid decarboxylase (GAD-A) autoantibodies were originally reported in patients with stiff-man syndrome (SMS).1 Successive studies have shown that GAD-A was implicated in the pathogenesis of type 1 diabetes.2 High titers of GAD-A were recently reported in neurologic patients with disorders other than SMS, in particular ataxia3,4⇓ and therapy-resistant epilepsy.5,6⇓ We report a woman with type 1 diabetes who developed a subacute encephalitis associated with high titer of GAD-A. A 27-year-old woman with type 1 diabetes was admitted with a 1-week history of changes in her behavior, temporal disorientation, and myoclonus of her left arm. Blood glucose level was slightly elevated in serial tests. She was febrile and the neurologic examination disclosed no focal abnormalities. On the first day, the patient had generalized fits and consciousness varied from stupor to coma. Electroencephalography showed right temporal spikes and MRI scan was unremarkable. CSF analysis showed …