Anita M Vinke1, Frédéric L W V J Schaper2, Mariëlle C G Vlooswijk3, Joost Nicolai3, Marian H J M Majoie4, Pilar Martinez Martinez5, Carolin Hoffmann5, Jan G M C Damoiseaux6, Rob P W Rouhl7. 1. Department of Neurology, Maastricht University Medical Center (MUMC+), Maastricht, The Netherlands. 2. Department of Neurology, Maastricht University Medical Center (MUMC+), Maastricht, The Netherlands; Department of Neuroscience, Maastricht University, The Netherlands. 3. Department of Neurology, Maastricht University Medical Center (MUMC+), Maastricht, The Netherlands; Academic Center for Epileptology (ACE) Kempenhaeghe/MUMC+, Heeze and Maastricht, The Netherlands; School for Mental Health and Neuroscience (MHeNS), Maastricht University, Maastricht, The Netherlands. 4. Academic Center for Epileptology (ACE) Kempenhaeghe/MUMC+, Heeze and Maastricht, The Netherlands; School for Mental Health and Neuroscience (MHeNS), Maastricht University, Maastricht, The Netherlands;; School of Health Professions Education, Maastricht University, The Netherlands. 5. Department of Neuroscience, Maastricht University, The Netherlands; School for Mental Health and Neuroscience (MHeNS), Maastricht University, Maastricht, The Netherlands. 6. Department of Central Diagnostic Laboratory, Maastricht University Medical Center (MUMC+), Maastricht, The Netherlands. 7. Department of Neurology, Maastricht University Medical Center (MUMC+), Maastricht, The Netherlands; Academic Center for Epileptology (ACE) Kempenhaeghe/MUMC+, Heeze and Maastricht, The Netherlands; School for Mental Health and Neuroscience (MHeNS), Maastricht University, Maastricht, The Netherlands;. Electronic address: R.Rouhl@mumc.nl.
Abstract
OBJECTIVE: Antiglutamate decarboxylase (anti-GAD) antibodies are associated with several neurological manifestations, like epilepsy and movement disorders. However, in daily neurological practice, it remains hard to define when to test for anti-GAD antibodies in patients with neurologic and/or psychiatric symptoms. Therefore, here, we report the patient characteristics of a large retrospective cohort of patients tested for anti-GAD antibodies in clinical practice and compare the characteristics of anti-GAD positive and anti-GAD negative patients. METHODS: We blindly assessed relevant clinical symptoms and comorbidities and functional outcome with the modified Rankin Scale (mRS) in a retrospective observational cohort of all patients in which the decision to assess anti-GAD levels had been made based solely on the presence of possible associated neurological and/or psychiatric symptoms (N=119). RESULTS: Out of 119 patients, 17 (14.3%) were anti-GAD positive. The anti-GAD positive patients had a median age of 30years (range: 3-64; 2 children). They all had epilepsy, with 8 (47%) patients reporting cognitive complaints. Psychiatric symptoms were less prevalent in anti-GAD positive patients, only 1 anti-GAD positive patient (6%) versus 34 anti-GAD negative patients (33%) reported psychiatric symptoms (p=0.021). The most frequent comorbidity of anti-GAD positive patients was diabetes mellitus type 1 (n=8). Twelve (71%) and 13 (78%) of the anti-GAD positive patients were functionally independent at the time of diagnosis and after one year, respectively (mRS score: 0 to 2). There was no significant difference in functional status at any time during follow-up compared with the anti-GAD negative group. CONCLUSION: Antiglutamate decarboxylase (anti-GAD) antibodies relate to epilepsy with or without cognitive complaints. However, psychiatric symptoms were almost absent in anti-GAD positive patients, and the presence of anti-GAD antibodies contributed little to the prognosis in our cohort.
OBJECTIVE: Antiglutamate decarboxylase (anti-GAD) antibodies are associated with several neurological manifestations, like epilepsy and movement disorders. However, in daily neurological practice, it remains hard to define when to test for anti-GAD antibodies in patients with neurologic and/or psychiatric symptoms. Therefore, here, we report the patient characteristics of a large retrospective cohort of patients tested for anti-GAD antibodies in clinical practice and compare the characteristics of anti-GAD positive and anti-GAD negative patients. METHODS: We blindly assessed relevant clinical symptoms and comorbidities and functional outcome with the modified Rankin Scale (mRS) in a retrospective observational cohort of all patients in which the decision to assess anti-GAD levels had been made based solely on the presence of possible associated neurological and/or psychiatric symptoms (N=119). RESULTS: Out of 119 patients, 17 (14.3%) were anti-GAD positive. The anti-GAD positive patients had a median age of 30years (range: 3-64; 2 children). They all had epilepsy, with 8 (47%) patients reporting cognitive complaints. Psychiatric symptoms were less prevalent in anti-GAD positive patients, only 1 anti-GAD positive patient (6%) versus 34 anti-GAD negative patients (33%) reported psychiatric symptoms (p=0.021). The most frequent comorbidity of anti-GAD positive patients was diabetes mellitus type 1 (n=8). Twelve (71%) and 13 (78%) of the anti-GAD positive patients were functionally independent at the time of diagnosis and after one year, respectively (mRS score: 0 to 2). There was no significant difference in functional status at any time during follow-up compared with the anti-GAD negative group. CONCLUSION: Antiglutamate decarboxylase (anti-GAD) antibodies relate to epilepsy with or without cognitive complaints. However, psychiatric symptoms were almost absent in anti-GAD positive patients, and the presence of anti-GAD antibodies contributed little to the prognosis in our cohort.
Authors: Julia C Kuehn; Carolin Meschede; Christoph Helmstaedter; Rainer Surges; Randi von Wrede; Elke Hattingen; Hartmut Vatter; Christian E Elger; Susanne Schoch; Albert J Becker; Julika Pitsch Journal: PLoS One Date: 2020-10-29 Impact factor: 3.240