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Serum glutamate decarboxylase antibodies and neurological disorders: when to suspect their association?

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Abstract

Objectives

To explore different neurological manifestations with suspicion of being associated to serum glutamate decarboxylase antibodies (GAD-Abs) in order to better characterize anti-GAD neurological syndromes.

Methods

Observational retrospective study including all patients for whom GAD65-Abs titers in serum were requested by the Neurology Department at La Paz University Hospital between 2015 and 2019. GAD-Abs were measured by ELISA. Demographic data, neurological symptoms, comorbidity with diabetes mellitus (DM) or with another autoimmune disease, and GAD-Abs titers were studied. Stiff-person syndrome, ataxia, encephalitis, and epilepsy were considered typical anti-GAD neurological syndromes and were compared to other atypical manifestations.

Results

A total of 173 patients (51.7% men, mean age 51.62) were included. A progressive increase in requests of serum GAD-Abs has occurred over the last 5 years, especially in patients with atypical neurological manifestations. GAD-Abs were found in the serum of 22 patients (12.7%); of those, 15 (68.18%) suffered a typical anti-GAD syndrome. Presence of DM or another organ-specific autoimmune disease was predictive of GAD-AB seropositivity (p < 0.001). 6.6% of requested patients with an atypical syndrome had GAD-Abs, but serum levels were significantly lower than those found in patients with a typical syndrome (706.67 vs 1430.23 UI/mL; Mann-Whitney U, p = 0.034), and were finally diagnosed with another neurological disease.

Conclusion

Serum GAD-Abs were infrequently found in patients with clinical phenotypes other than those classically described as anti-GAD disorders, and with very low titers. In typical anti-GAD syndromes, there is a high comorbidity with DM and with other autoimmune diseases, and high serum GAD-Abs levels are usually present.

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Authors and Affiliations

  1. Department of Neurology, Hospital Universitario La Paz, Paseo de la Castellana, 261, 28046, Madrid, Spain

    Laura Lacruz Ballester, Mireya Fernandez-Fournier, Inmaculada Puertas Muñoz, Clara Lastras Fernandez-Escandon, Francisco Javier Rodriguez de Rivera Garrido, Elda Maria Alba Suarez & Antonio Tallon Barranco

  2. Department of Clinical Analysis, Hospital Universitario La Paz, Paseo de la Castellana, 261, 28046, Madrid, Spain

    Olaia Rodriguez Fraga

Authors
  1. Laura Lacruz Ballester
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  2. Mireya Fernandez-Fournier
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Correspondence to Laura Lacruz Ballester.

Ethics declarations

Informed consents are not required in view of the retrospective nature of the study and all the procedures being performed were part of the routine care, and as long as information is anonymized and the submission does not include images that may identify the person.

Ethical approval

Ethical approval was obtained from the Local Ethics Committee of La Paz University Hospital (Date 8/10/2019; N° PI-3818).

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The authors declare no competing interests.

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Lacruz Ballester, L., Fernandez-Fournier, M., Puertas Muñoz, I. et al. Serum glutamate decarboxylase antibodies and neurological disorders: when to suspect their association?. Neurol Sci 43, 633–641 (2022). https://doi.org/10.1007/s10072-021-05281-4

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