Aim of study. Glutamate decarboxylase (GAD) enzyme can be a target intracellular antigen
in autoimmune focal epilepsy. GAD65 antibody is in found patients diagnosed with drug-refractory
temporal lobe epilepsy (TLE). We explore the clinical features of the disease and
therapeutic options. Material and methods. We present the cases of four TLE patients,
two of them with type 1 diabetes. All of them were drug-resistant and therefore underwent
presurgical evaluation, which revealed GAD65 antibody positivity. We discuss the four
GAD65 antibody positive temporal lobe epilepsy patients' electroclinical data, the
treatments, and their effectiveness. Results. One of them became seizure-free after
right anterior temporal lobe resection, two of them did not show significant improvement
with immunmodulatory agents, and the fourth patient with the shortest duration of
disease had significant improvement in seizure status and normalisation of cognitive
status with IVIg therapy. Conclusions and clinical implications. Our cases show that
the earlier a GAD65 antibody is detected, the greater the chance of achieving seizure
freedom or improvements in both seizure and cognitive status with immunomodulatory
agents. However, in some cases, surgery may also bring seizure freedom, but with a
risk of cognitive deterioration.
