Glutamic acid decarboxylase antibodies in neurocritical patients: a culprit or a bystander?
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ORIGINAL ARTICLE
Glutamic acid decarboxylase antibodies in neurocritical patients: a culprit or a bystander? Dongmei Wang 1 & Kaibin Huang 1 & Zhenzhou Lin 1 & Yongfang Zhang 1 & Guanghui Liu 1 & Yongming Wu 1 & Shengnan Wang 1 Received: 22 February 2020 / Accepted: 9 May 2020 # Fondazione Società Italiana di Neurologia 2020
Abstract Background Glutamic acid decarboxylase (GAD) is an intracellular enzyme, which is widely expressed in central nervous system (CNS), pancreas, and other organs. GAD antibodies (GAD-Abs) are linked to various neurological disorders. However, the significance of GAD-Abs in neurocritical patients is undetermined. Materials and methods Patients with serologically positive GAD-Abs and requiring neurocritical care were included. The clinical, laboratory, and outcome data were retrospectively collected. Results We included 9 patients with serologically positive GAD-Abs. Clinical manifestations involved both CNS and peripheral nervous system (PNS). Six (66.7%) patients had other specific autoimmune antibodies. Non-specific autoimmune responses were observed in 8 (88.9%) patients. All patients clinically responded well to immunotherapy. The titers of GAD-Abs decreased in 7 (77.8%) patients but remained unchanged in the other 2 patients. One (11.1%) patient awoke before the negative conversion of GAD-Abs, and 3 (33.3%) patients remained unconscious and/or under mechanical ventilation for several weeks after the vanishing of GAD-Abs. Conclusions Most neurocritical patients with serologically positive GAD-Abs had other specific autoimmune antibodies. All patients responded well to immunotherapy, but not parallel to the titers of GAD-Abs. These results indicated that GAD-Abs might be more a bystander than a culprit in neurocritical patients, suggesting that an underlying autoimmune disease should be explored. Keywords Glutamic acid decarboxylase . Autoimmune . Antibodies . Neurocritical Dongmei Wang and Kaibin Huang contributed equally to this work. Contribution to the field statement Glutamic acid decarboxylase antibodies (GAD-Abs) are linked to various neurological disorders that seldom develop into life-threatening conditions; however, advances in the detection of antibodies have identified an increasing number of neurocritical patients that are afflicted by GAD-Abs. In this study, we summarized the clinical features and overlapping autoimmune antibodies in neurocritical patients. We found that neurocritical patients presenting with positive GAD-Abs more likely progressed to acute and subacute coma, status epilepticus (SE), and refractory SE. Additionally, these same patients exhibit a common overlap with other autoimmune antibodies. Most patients appeared to benefit from plasma exchange therapy. * Yongming Wu [email protected]
Yongfang Zhang [email protected]
* Shengnan Wang [email protected]
Guanghui Liu [email protected]
Dongmei Wang [email protected] Kaibin Huang [email protected] Zhenzhou Lin [email protected]
1
Neurology Department, Nanfang Hospital, Southern Medical University, 1838 Nor
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