Department of Neurology, China-Japan Union Hospital of Jilin University, Changchun, Jilin Province, China.
Department of Neurology, China-Japan Union Hospital of Jilin University, Changchun, Jilin Province, China.
J Neuroimmunol. 2020 Apr 15;341:577189. doi: 10.1016/j.jneuroim.2020.577189. Epub 2020 Feb 14.
Anti-GAD65 antibodies have been identified in both acute/subacute seizures (limbic encephalitis and extralimbic encephalitis) and chronic isolated epilepsy. The evidence of high serum titers and intrathecal synthesis play a fundamental role in diagnosis but poorly correlate with disease severity or response to therapies. It remains controversial whether anti-GAD65 Abs are the pathogenic entity or only serve as a surrogate marker for autoimmune disorders mediated by cytotoxic T cells. Unlike other immune-mediated epilepsy, although multiple combinations of therapeutics are used, the efficacy and prognosis of patients with GAD65-epilepsy patients are poor. Besides, GAD65-epilepsy is more prone to relapse and potentially evolve into a more widespread CNS inflammatory disorder. This article reviews the recent advances of GAD65-epilepsy, focusing on the diagnosis, epidemiology, pathophysiology, clinical features, and treatment, to better promote the recognition and provide proper therapy for this condition.
抗谷氨酸脱羧酶 65 抗体（Anti-GAD65 antibodies）已在急性/亚急性发作（边缘性脑炎和边缘外脑炎）和慢性孤立性癫痫中被识别。高血清滴度和鞘内合成的证据在诊断中起着重要作用，但与疾病严重程度或对治疗的反应相关性差。抗 GAD65 Abs 是否是致病实体，还是仅作为细胞毒性 T 细胞介导的自身免疫性疾病的替代标志物，这仍然存在争议。与其他免疫介导的癫痫不同，尽管使用了多种治疗组合，但 GAD65 癫痫患者的疗效和预后较差。此外，GAD65 癫痫更容易复发，并有可能发展为更广泛的中枢神经系统炎症性疾病。本文综述了 GAD65 癫痫的最新进展，重点介绍了其诊断、流行病学、病理生理学、临床特征和治疗，以更好地促进对这种疾病的认识并提供适当的治疗。
