Early Immunosuppression and Seizure Control Associated with Excellent Outcome in Anti-Gad65 Encephalitis: A Case Report

We present the case of an 18 year old female who presented with short term amnesia, palpitations and headaches with no significant past medical history. Examination revealed inability to recall three objects, autonomic dysfunction and no focal neurological deficit. She was initially treated with intravenous antibiotics and antiviral medication to cover for infectious causes of encephalitis. She was also treated with IV antiepileptic medication after her EEG demonstrated epilepsy partialis continua. She later received intravenous steroids and intravenous immunoglobulin for treatment of presumed autoimmune encephalitis once infection was ruled out. She proceeded to second line immunosuppression with mycophenolate and rituximab. Her antineuronal antibodies in her cerebrospinal fluid later returned positive for anti-glutamic acid decarboxylase 65 (GAD-65). At follow up at 1 month and 6 months, our patient had significant recovery in her memory and cognitive function. We postulate an early aggressive seizure control and immunosuppression strategy of steroids, intravenous immunoglobulin, mycophenolate and rituximab pending antibody results was key to her good outcome.