Gardner Rachael, Rangaswamy Rajesh, Peng Yen-Yi
Renown Institute for Neurosciences, Renown Health; Department of Neurology, University of Nevada, Reno, NV, USA.
Radiology Department, Renown Institute for Neurosciences, Renown Health, Reno, NV, USA.
J Clin Med Res. 2016 Aug;8(8):616-22. doi: 10.14740/jocmr2624w. Epub 2016 Jul 1.
With the increased availability of laboratory tests, glutamic acid decarboxylase (GAD) antibody-positive limbic encephalitis has become an emerging diagnosis. The myriad symptoms of limbic encephalitis make the diagnosis challenging. Symptoms range from seizures, memory loss, dementia, confusion, to psychosis. We present a case of a 21-year-old female with GAD65 antibody-positive limbic encephalitis. The case is unique because the clinical course suggests that non-convulsive seizures are the major cause of this patient's clinical manifestations. The following is the thesis: systemic autoimmune disease, associated with the GAD65 antibody, gives rise to seizures, in particular, non-convulsive seizures. Temporal lobes happen to be the most susceptible sites to develop seizures. The greater part of these seizures can be non-convulsive and hard to recognize without electroencephalogram (EEG) monitoring. The variable symptoms mirror the severity and locations of these seizures. The magnetic resonance imaging (MRI) signal abnormities in the bilateral hippocampus, fornix, and mammillary body correlate with the density of these seizures in the similar manner, which suggests it is secondary to post-ictal edema.
随着实验室检测方法的增多，谷氨酸脱羧酶（GAD）抗体阳性的边缘叶脑炎已成为一种新出现的诊断疾病。边缘叶脑炎的症状多种多样，这使得诊断具有挑战性。症状包括癫痫发作、记忆力减退、痴呆、意识模糊以及精神错乱等。我们报告一例21岁女性GAD65抗体阳性边缘叶脑炎病例。该病例独特之处在于其临床病程提示非惊厥性癫痫发作是该患者临床表现的主要原因。以下是论点：与GAD65抗体相关的系统性自身免疫性疾病引发癫痫发作，尤其是非惊厥性癫痫发作。颞叶恰好是最易发生癫痫发作的部位。这些癫痫发作大多可能是非惊厥性的，若无脑电图（EEG）监测则难以识别。症状的多样性反映了这些癫痫发作的严重程度和部位。双侧海马、穹窿和乳头体的磁共振成像（MRI）信号异常以类似方式与这些癫痫发作的密度相关，这表明其继发于发作后水肿。
