Abstract Details

Title Drug-Resistant GAD65-Associated Epilepsy: Pre-Surgical Evaluation and Comparison to Temporal Lobe Epilepsy of Other Etiology

Topic Epilepsy/Clinical Neurophysiology (EEG)

Presentation(s) P2 - Poster Session 2 (8:00 AM-9:00 AM)

Poster/Presentation
Number 9-005

Objective The objective of this study was to describe the evaluation for patients with drug-resistant epilepsy associated with high-titer GAD65 antibodies and compare clinical factors with a control group of patients with temporal lobe epilepsy and negative GAD65 antibodies.

Background High-titer GAD65 antibodies are associated with chronic temporal lobe epilepsy. The recognition of epilepsy associated with GAD65 antibodies has treatment and prognostic implications.

Design/Methods From a list of 1432 patients presented at a single institution Surgical Epilepsy Conference from 1/1/2007-6/13/2024, patients with epilepsy associated with high-titer serum GAD65 antibodies (>20 nmol/L) were identified. Charts were reviewed to describe clinical, EEG, and imaging characteristics. Age and sex matched controls with drug-resistant, temporal lobe epilepsy who were negative for high-titer GAD65 antibodies served as a control group.

Results Fifteen patients (13 females, 86.7%) were identified with drug-resistant epilepsy associated with high-titer GAD65 antibodies (median serum titer=960 nmol/L; range 34-4678 nmol/L). The median age of epilepsy onset was 25 years (range 4-44 years). All patients had temporal lobe epilepsy, with independent bitemporal onset seizures on scalp EEG in 7 patients (47%). Three patients initially presented with limbic encephalitis, and three patients developed mesial temporal sclerosis (2 bilateral, 1 unilateral). Limbic encephalitis, musicogenic seizures, and type 1 diabetes were only present in those with GAD65 antibodies when compared to the control group, but these differences did not reach statistical significance, nor did age of onset, seizure characteristics and frequency, autoimmune history, or EEG or imaging findings.

Conclusions High-titer GAD65 antibodies are associated with drug-resistant epilepsy, frequently with bitemporal involvement. While it may be difficult to differentiate those with GAD65-associated epilepsy from those with temporal lobe epilepsy not related to GAD65 antibodies, limbic encephalitis, musicogenic seizures, and type 1 diabetes were only observed in patients with GAD65-associated epilepsy.

Authors/Disclosures
Anna Thomsen, MD PRESENTER	Dr. Thomsen has nothing to disclose.
Gloria Ortiz Guerrero, MD	Dr. Ortiz Guerrero has nothing to disclose.
Jeffrey W. Britton, MD, FAAN (Mayo Graduate School of Medicine)	Dr. Britton has received personal compensation in the range of $0-$499 for serving as a Online course with American Clinical Neurophysiology Society.
Divyanshu Dubey, MD, FAAN (Mayo Clinic)	The institution of Dr. Dubey has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Argenx. The institution of Dr. Dubey has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Arialys. The institution of Dr. Dubey has received personal compensation in the range of $500-$4,999 for serving as a Consultant for UCB . Dr. Dubey has received research support from Department of Defense . Dr. Dubey has received research support from Department of Defense . Dr. Dubey has received research support from UCB. Dr. Dubey has received research support from David J. Tomassoni ALS Research Grant Program . Dr. Dubey has received intellectual property interests from a discovery or technology relating to health care. Dr. Dubey has received intellectual property interests from a discovery or technology relating to health care. Dr. Dubey has received intellectual property interests from a discovery or technology relating to health care. Dr. Dubey has received intellectual property interests from a discovery or technology relating to health care.
Kelsey M. Smith, MD (Mayo Clinic)	The institution of Dr. Smith has received research support from CURE Epilepsy. The institution of Dr. Smith has received research support from UCB Pharmaceuticals.

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