Super refractory status epilepticus secondary to anti-GAD antibody encephalitis successfully treated with aggressive immunotherapy
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Elsevier Inc.
Abstract
Antibodies against glutamic acid decarboxylase are reported in association with a number of neurological conditions including limbic encephalitis. We report a case of anti-GAD-antibody associated encephalitis presenting with super-refractory status epilepticus. We describe the clinical course, management, and the outcome. In addition, we review the presentation and outcomes of reported cases of anti-GAD encephalitis. Similar to the reported cases of anti-GAD encephalitis, our case was refractory to treatment with conventional antiseizure medication. Treatment with intravenous immune globulin (IVIG), high dose corticosteroids, and plasmapheresis had partial response, but escalation of treatment to the use of tocilizumab was associated with significant clinical improvement. © 2020 The Authors
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Keywords
Autoimmune encephalitis, Glutamic acid decarboxylase antibodies, Limbic encephalitis, Status epilepticus, Tocilizumab, Aciclovir, Antiinfective agent, Clobazam, Clonazepam, Foscarnet, Glutamate decarboxylase antibody, Immunoglobulin, Ketamine, Lacosamide, Levetiracetam, Methylprednisolone, Midazolam, Perampanel, Phenobarbital, Phenytoin, Propofol, Topiramate, Triacylglycerol lipase, Valproic acid, Allergic encephalitis, Antibiotic therapy, Antibody blood level, Antiviral therapy, Article, Brain atrophy, Brain infection, Case report, Cerebrospinal fluid analysis, Child, Clinical article, Clinical feature, Clinical outcome, Consciousness disorder, Continuous infusion, Corticosteroid therapy, Disease course, Disorientation, Drug infusion, Drug megadose, Drug resistant epilepsy, Drug substitution, Drug withdrawal, Electroencephalography, Extubation, Female, Fever, Focal epilepsy, Follow up, Gastroenteritis, Glutamate decarboxylase antibody encephalitis, Hospital admission, Human, Hyperreflexia, Immunotherapy, Ketogenic diet, Motor dysfunction, Neuroimaging, Nuclear magnetic resonance imaging, Paraneoplastic neuropathy, Patient care, Plasmapheresis, Pleocytosis, Priority journal, Respiratory tract intubation, School child, Temporal lobe, Treatment duration