Case 1: A 56-year-old Tanzanian male presented in 2021 with back and lower limb pain and stiffness, with upper motor neuron findings on examination. His electromyograph was suggestive of stiff person syndrome. Serum anti-GAD 65 antibodies were negative. He was started on diazepam and intravenous immunoglobulin (IVIG), and later rituximab. Repeat investigations in January 2024 showed a positive CSF GAD-65 antibody. He objectively improved with increased mobility and improved speech.
Case 2: A 60-year-old Kenyan female, with rheumatoid arthritis, presented in 2020 with new-onset ataxia. MRI brain showed pan-cerebellar atrophy. Her serum anti-GAD 65 antibodies were positive and malignancy screen was negative. She was treated with corticosteroids and mycophenolate. Her SARA score improved from 6 at onset to 0 and she is now able to function independently.
Case 3: A 36-year-old Kenyan female presented with a decade of medically refractory temporal lobe seizures. An MRI brain scan in 2021 showed new hippocampal sclerosis and she was referred abroad for epilepsy surgery. Her seizures recurred 6 months postoperatively, and repeat investigations revealed a positive anti-GAD antibody. She was treated with steroids, IVIG and then rituximab and she became seizure-free
Case 4: A 21-year old Kenyan female presented with new onset lingual seizures, left face and hand twitching and impaired short-term memory. MRI brain showed enhancing inflammatory lesions including in the right hippocampus. Her serum anti-GAD antibody was positive. She received intravenous steroids, plasma exchange and IVIg and has improved.