Statistics from Altmetric.com
If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.
Glutamic acid decarboxylase (GAD) catalyses the transformation of glutamate into γ-aminobutyric acid (GABA). Anti-GAD autoantibodies (GAD-Ab) have been associated with insulin-dependent diabetes mellitus (IDDM) and with other possibly immunomediated syndromes affecting the CNS including stiff-man syndrome (SPS),1 progressive encephalomyelitis with rigidity and myoclonus (PERM) and cerebellar ataxia,1 2 mostly in association with IDDM. These findings support the autoimmune origin of the neurological symptoms, possibly induced by an anti-GAD-Ab-mediated neuronal dysfunction. Manto et al3 induced cerebellar and spinal cord symptoms in rats, by intrathecal injection of IgG from anti-GAD-Ab positive patients affected by SPS or cerebellar ataxia, suggesting a pathogenetic mechanisms involving a change of balance between glutamate and GABA, causing glutamate excitotoxicity.
High-dose intravenous immunoglobulins and plasmapheresis have been suggested as possible therapies, but cerebellar symptoms have been rarely found to improve. Recently Lauria et al4 induced clinical improvement in a patient with anti-GAD-Ab cerebellar ataxia through high doses of methylprednisolone, suggesting that it should be considered as first-line therapy in these patients. We describe a 76-year-old man developing an anti-GAD associated subacute cerebellar syndrome that improved dramatically after steroid treatment.
A 76-year-old man was admitted to our clinic in January 2007 for the development, since June 2006, of a subacute progressive gait instability and loss of fluency of movement execution. Within 3 months, …
Competing interests: None.
Ethics approval: Provided by Ethical Committee of IRCCS Foundation Ospedale Maggiore Policlinico Mangiagalli and Regina Elena, Milan, Italy.
Patient consent: Obtained.