New-onset drug-resistant epilepsy in type 1 diabetes mellitus patient following COVID-19 vaccination: suspicious for autoimmune pathogenesis.

INTRODUCTION

Within the spectrum of epilepsies, autoimmune-associated epilepsy (AAE) reflects the complexity of its presentations including refractory seizures along with cognitive decline and behavioral or psychiatric dysfunction. The suspicion of autoimmune epilepsy is heightened in individuals who have a pre-existing autoimmune condition, such as type 1 diabetes mellitus (T1DM). This report details a case of autoimmune epilepsy associated with Glutamic acid decarboxylase (GAD65) antibodies coexisting with T1DM.

CASE DESCRIPTION

The subject of this clinical case is a 48-year-old male with a history of T1DM and hypothyroidism, who exhibited new behavioral alterations and refractory focal seizures two weeks post- COVID-19 vaccination. Initially, his symptoms were misinterpreted as panic attacks. Months later, these attacks were diagnosed as focal epilepsy after multiple evaluations including, interictal and ictal electroencephalograms, brain Magnetic Resonance Imaging (MRI), and Positron Emission Tomography (PET). The patient underwent several trials of antiseizure medications and their combinations, yet no significant effects were observed. The Antibody Prevalence in Epilepsy and Encephalopathy (APE2) score was determined, yielding a result of 4, and the presence of elevated Glutamic acid decarboxylase (GAD65) antibodies in the serum led to a confirmed diagnosis of autoimmune encephalitis (AAE). Following a course of intravenous immunoglobulin, no notable improvement was recorded; however, subsequent corticosteroid therapy, accompanied by rigorous blood glucose monitoring, resulted in a positive but partial reduction in seizure frequency. The patient was planned to start on long-term use of azathioprine.

CONCLUSION

This case exemplifies the diagnostic challenges inherent in autoimmune-associated epilepsy and underscores the necessity for prompt intervention. Glutamic acid decarboxylase (GAD65) antibody-associated autoimmune epilepsy should be suspected in adult-onset temporal lobe epilepsy with co-morbid type 1 DM with early initiation of immune therapy for better clinical outcomes.