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@ARTICLE{Widman:824547,
      author       = {Widman, Guido and Golombeck, Kristin and Hautzel, Hubertus
                      and Gross, Catharina C. and Quesada, Carlos M. and Witt,
                      Juri-Alexander and Rota Kops, Elena and Ermert, Johannes and
                      Greschus, Susanne and Surges, Rainer and Helmstaedter,
                      Christoph and Wiendl, Heinz and Melzer, Nico and Elger,
                      Christian E.},
      title        = {{T}reating a {GAD}65 {A}ntibody-{A}ssociated {L}imbic
                      {E}ncephalitis with {B}asiliximab: {A} {C}ase {S}tudy},
      journal      = {Frontiers in neurology},
      volume       = {6},
      issn         = {1664-2295},
      address      = {Lausanne},
      publisher    = {Frontiers Research Foundation},
      reportid     = {FZJ-2016-07119},
      pages        = {167},
      year         = {2015},
      abstract     = {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.},
      cin          = {KME / INM-4 / INM-5},
      ddc          = {610},
      cid          = {I:(DE-Juel1)VDB145 / I:(DE-Juel1)INM-4-20090406 /
                      I:(DE-Juel1)INM-5-20090406},
      pnm          = {572 - (Dys-)function and Plasticity (POF3-572)},
      pid          = {G:(DE-HGF)POF3-572},
      typ          = {PUB:(DE-HGF)16},
      UT           = {WOS:000363857200001},
      pubmed       = {pmid:26284025},
      doi          = {10.3389/fneur.2015.00167},
      url          = {https://juser.fz-juelich.de/record/824547},
}