0
We're unable to sign you in at this time. Please try again in a few minutes.
Retry
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
Retry
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Editorial |

Association of Paraneoplastic Neurological Disorders With Glutamic Acid Decarboxylase Antibodies

Christian G. Bien, MD1
[+] Author Affiliations
1Epilepsy Centre Bethel, Krankenhaus Mara, Bielefeld, Germany
JAMA Neurol. 2015;72(8):861-862. doi:10.1001/jamaneurol.2015.1068.
Text Size: A A A
Published online

Extract

An increasing number of antineural IgG antibodies have been detected since the 1980s in patients with autoimmune central nervous system disease. Antibodies to intracellular antigens were initially found and antibodies to antigens on the neural surface have now been identified. Antibodies to the intracellular enzyme glutamic acid decarboxylase (GAD) were one of the earliest antibodies discovered.1 However, not all antibodies have the same value. This means that not all are pathogenic, specific for defined syndromes, and indicative for responsiveness to immunological treatment. Antibodies to the N-methyl-d-aspartate receptor and defined antigens in the voltage-gated potassium channel complex, such as leucine-rich glioma inactivated protein 1 and contactin-associated protein 2 (most likely the antibodies to the α-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid receptor, the γ-aminobutyric acid B receptor, the glycine receptor, and others as well), are high-rank antibodies in that sense. However, other antibodies have their flaws because they lack 1 or more of these criteria. Antibodies to GAD are quite specific and are found in stiff-man syndrome, cerebellar ataxia, limbic encephalitis, and temporal lobe epilepsy.2 Specificity beyond 1 single syndrome is not uncommon. Even the high-rank antibodies are not entirely specific, as observed in the N-methyl-d-aspartate receptor antibodies.3,4 However, as already discussed in the Solimena et al article,1 the intracellular location of GAD makes an in vivo immunological reaction unlikely; GAD antibodies are probably not pathogenic on their own.1 The response of GAD antibodies to treatment is not as effective as, for example, antibodies to elements of the voltage-gated potassium channel complex.5 Taken together, GAD antibodies, even if they are high titer, are somehow considered second-class antibodies.

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

First Page Preview

View Large
First page PDF preview

Figures

Tables

References

Correspondence

CME
Also Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Please click the checkbox indicating that you have read the full article in order to submit your answers.
Your answers have been saved for later.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.

Multimedia

Some tools below are only available to our subscribers or users with an online account.

886 Views
1 Citations
×

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

Related Content

Customize your page view by dragging & repositioning the boxes below.

See Also...
Articles Related By Topic
Related Collections
PubMed Articles
Jobs
brightcove.createExperiences();