%0 Journal Article
%A Widman, Guido
%A Golombeck, Kristin
%A Hautzel, Hubertus
%A Gross, Catharina C.
%A Quesada, Carlos M.
%A Witt, Juri-Alexander
%A Rota Kops, Elena
%A Ermert, Johannes
%A Greschus, Susanne
%A Surges, Rainer
%A Helmstaedter, Christoph
%A Wiendl, Heinz
%A Melzer, Nico
%A Elger, Christian E.
%T Treating a GAD65 Antibody-Associated Limbic Encephalitis with Basiliximab: A Case Study
%J Frontiers in neurology
%V 6
%@ 1664-2295
%C Lausanne
%I Frontiers Research Foundation
%M FZJ-2016-07119
%P 167
%D 2015
%X Background: Antibodies (ABs) against the 65-kDa isoform of the intracellular enzymeglutamate decarboxylase (GAD65) have been found in limbic encephalitis (LE) andother neurological conditions. The direct significance of anti-GAD65-ABs for epilepsyis unclear. However, in histological preparations from biopsies of resective epilepsysurgeries, predominantly cytotoxic T-lymphocytes were detected making close contactsto neurons. Activated T-lymphocytes can, in turn, be selectively controlled by therapeuticinterleukin-2 receptor Abs, such as basiliximab.Case presentation: We report of a 25-year-old male patient with epilepsy since theage of 18 and displaying clinical signs of LE and a high titer of GAD65 ABs in cerebro-spinal fluid (CSF) and serum. Monthly, repetitive, intravenous cortisone pulse therapiesthat were initially administered for 6 months failed to improve his condition. Subsequentflow-cytometry analysis of CSF showed especially an increased fraction of activatedHLA-DR+CD8+T-lymphocytes (fCD8+TL) when compared to controls. Thus, a second,intravenous cortisone pulse therapy with an additional basiliximab dose of 20 mg/monthwas started. After 3 months, the fCD8+TL in the CSF normalized; after 6 months, thepsychological impulse-control deficits normalized; and after 11 months the patientwas seizure free. However, 7 weeks later, seizures and, later on, psychological deficitsrecurred and fCD8+TL was once again present in the CSF. Flumazenil PET, magneticresonance imaging-volumetry, and neuropsychological changes during therapy aredescribed.Conclusion: The correlation of the fCD8+TL in the CSF with clinical and paraclinical measures of disease activity combined with the unambiguous response to basiliximabstrongly argues in favor of the putative pathogenic role fCD8+TL in anti-GAD65 LE. The clinical relapse at the end of the observation period might be due to the formation ofhuman anti-drug ABs, a well-known complication of therapy with chimeric ABs.
%F PUB:(DE-HGF)16
%9 Journal Article
%U <Go to ISI:>//WOS:000363857200001
%$ pmid:26284025
%R 10.3389/fneur.2015.00167
%U https://juser.fz-juelich.de/record/824547