Central nervous system autoimmunity in the pediatric age group represents an evolving constellation of various syndromes distinct from the adult age group.One of the rarely described pathogenic auto-antibodies(ab)is t...Central nervous system autoimmunity in the pediatric age group represents an evolving constellation of various syndromes distinct from the adult age group.One of the rarely described pathogenic auto-antibodies(ab)is the one directed against glutamic acid decarboxylase(GAD).While its pathogenic role is controversial,literature concerning adult patients abounds with heterogeneous presentations with epilepsy often as part of limbic encephalitis or chronic temporal lobe epilepsy and cerebellar ataxia accompanying endocrinopathies or paraneoplastic disorders.Diagnosis is often delayed until late adulthood.The authors report hitherto under-reported syndromes in the pediatric age group.The first case was a 3-year-old boy with sub-acute myoclonus-ataxia following a flu-like illness akin to para-infectious cerebellitis.The second case was a 7-year-old girl with long-standing chronic extratemporal partial epilepsy and electrical status epilepticus in sleep(ESES)with right hemiparesis and developmental delay.Investigations revealed two-four fold elevations in titres of GAD-65-ab.The absence of systemic diseases like diabetes and the dramatic clinical response to steroids as well as intravenous immunoglobulin in both the cases argued for GAD-ab mediated neuronal injury rather than a chance association.The concern exists regarding other potentially co-existent auto-ab to gamma-amino butyric acid and glycine receptors,and demonstration of intrathecal synthesis of GAD-ab would be ideal.This entity should be contemplated in children presenting with acute/sub-acute onset episodic or progressive ataxia or refractory cryptogenic focal epilepsy syndromes,epileptic encephalopathy such as ESES and worsening neurological deficits.These children ought to be maintained on regular follow-up for monitoring evolution of other autoimmune disorders in adult life.展开更多
Background: Measuring fasting C-peptide (FCP) and antibodies against Glutamic acid decarboxylase (GADA) and Islet cell antibodies (ICA) are not so commonly explored in children and young adults. Objectives: To assess ...Background: Measuring fasting C-peptide (FCP) and antibodies against Glutamic acid decarboxylase (GADA) and Islet cell antibodies (ICA) are not so commonly explored in children and young adults. Objectives: To assess the levels of FCP, GADA and ICA in subjects below the age of 25 years with DM and compare their levels to differentiate between Autoimmune and Non-Autoimmune Type 1 DM. Methodology: Blood samples of 93 subjects diagnosed with DM, reporting to the tertiary care hospital, were analysed for ICA, GADA and FCP. Receiver operating characteristics (ROC) curves were analysed to check the ability of autoimmune markers, BMI and C-peptide to differentiate between Autoimmune (Ai) and Non-Autoimmune (NonAi) diabetes. Results: 30/93 (32.2%) were positive for anti-GAD ab and/or ICA and categorised as Autoimmune (Ai), the most common antibody being, anti-GAD ab (80%) in them. The level of FCP among Ai compared to NonAi, was significantly low (p 20.75 nmol/l) as a very dependable test for diagnosing Ai, Type 1 DM, in children and young adults. Its sensitivity and specificity are in the range of 86.2% and 96.8% respectively. Low level of C-peptide (Conclusion: This study revealed predominant positivity for anti-GAD ab (80%) among Ai+ patients. ROC analysis shows GADA above 20.75 nmol/l and Fasting C-peptide < 0.36 nmol/l as a good indicator for diagnosing Ai in children and young adults.展开更多
We experienced the first case with autoimmune polyglandular syndrome type 3(anti-thyroid peroxidase ant ib ody-positive hypothyroidism and anti-glutamic acid decar boxylase antibody-positive diabetes) complicated by m...We experienced the first case with autoimmune polyglandular syndrome type 3(anti-thyroid peroxidase ant ib ody-positive hypothyroidism and anti-glutamic acid decar boxylase antibody-positive diabetes) complicated by miner alocorticoid-responsive hyponatremia of the elderly.This case is also a rare slowly progressive insulin-dependent diabetes mellitus(SPIDDM) case,for which the patient has been treated for many years with sulfonylurea or glinide.Our observation also demonstrated that glucose metabolism in autoimmune diabetes such as SPIDDM is influenced by appetite,thyroid function and glucocorticoid effect.展开更多
Type 1 diabetes can be classified into immune-mediated diabetes (type 1A) and idiopathic diabetes, which lacks immunological evidence for beta cell autoimmunity (type 1B). Type 1A diabetes is characterized by the pres...Type 1 diabetes can be classified into immune-mediated diabetes (type 1A) and idiopathic diabetes, which lacks immunological evidence for beta cell autoimmunity (type 1B). Type 1A diabetes is characterized by the presence of the anti-glutamic acid decarboxylase antibody (anti-GADab). Fulminant type 1 diabetes is classified as type 1B diabetes, and characterized by the absence of anti-GADab, flu-like symptoms, and elevated serum exocrine pancreatic enzymes. We report a type 1 diabetic patient who showed flu-like symptoms, elevated serum exocrine pancreatic enzymes, and an extremely high-titer of anti-GADab, manifesting the characteristics of both type 1A and fulminant type 1 diabetes.展开更多
文摘Central nervous system autoimmunity in the pediatric age group represents an evolving constellation of various syndromes distinct from the adult age group.One of the rarely described pathogenic auto-antibodies(ab)is the one directed against glutamic acid decarboxylase(GAD).While its pathogenic role is controversial,literature concerning adult patients abounds with heterogeneous presentations with epilepsy often as part of limbic encephalitis or chronic temporal lobe epilepsy and cerebellar ataxia accompanying endocrinopathies or paraneoplastic disorders.Diagnosis is often delayed until late adulthood.The authors report hitherto under-reported syndromes in the pediatric age group.The first case was a 3-year-old boy with sub-acute myoclonus-ataxia following a flu-like illness akin to para-infectious cerebellitis.The second case was a 7-year-old girl with long-standing chronic extratemporal partial epilepsy and electrical status epilepticus in sleep(ESES)with right hemiparesis and developmental delay.Investigations revealed two-four fold elevations in titres of GAD-65-ab.The absence of systemic diseases like diabetes and the dramatic clinical response to steroids as well as intravenous immunoglobulin in both the cases argued for GAD-ab mediated neuronal injury rather than a chance association.The concern exists regarding other potentially co-existent auto-ab to gamma-amino butyric acid and glycine receptors,and demonstration of intrathecal synthesis of GAD-ab would be ideal.This entity should be contemplated in children presenting with acute/sub-acute onset episodic or progressive ataxia or refractory cryptogenic focal epilepsy syndromes,epileptic encephalopathy such as ESES and worsening neurological deficits.These children ought to be maintained on regular follow-up for monitoring evolution of other autoimmune disorders in adult life.
文摘Background: Measuring fasting C-peptide (FCP) and antibodies against Glutamic acid decarboxylase (GADA) and Islet cell antibodies (ICA) are not so commonly explored in children and young adults. Objectives: To assess the levels of FCP, GADA and ICA in subjects below the age of 25 years with DM and compare their levels to differentiate between Autoimmune and Non-Autoimmune Type 1 DM. Methodology: Blood samples of 93 subjects diagnosed with DM, reporting to the tertiary care hospital, were analysed for ICA, GADA and FCP. Receiver operating characteristics (ROC) curves were analysed to check the ability of autoimmune markers, BMI and C-peptide to differentiate between Autoimmune (Ai) and Non-Autoimmune (NonAi) diabetes. Results: 30/93 (32.2%) were positive for anti-GAD ab and/or ICA and categorised as Autoimmune (Ai), the most common antibody being, anti-GAD ab (80%) in them. The level of FCP among Ai compared to NonAi, was significantly low (p 20.75 nmol/l) as a very dependable test for diagnosing Ai, Type 1 DM, in children and young adults. Its sensitivity and specificity are in the range of 86.2% and 96.8% respectively. Low level of C-peptide (Conclusion: This study revealed predominant positivity for anti-GAD ab (80%) among Ai+ patients. ROC analysis shows GADA above 20.75 nmol/l and Fasting C-peptide < 0.36 nmol/l as a good indicator for diagnosing Ai in children and young adults.
文摘We experienced the first case with autoimmune polyglandular syndrome type 3(anti-thyroid peroxidase ant ib ody-positive hypothyroidism and anti-glutamic acid decar boxylase antibody-positive diabetes) complicated by miner alocorticoid-responsive hyponatremia of the elderly.This case is also a rare slowly progressive insulin-dependent diabetes mellitus(SPIDDM) case,for which the patient has been treated for many years with sulfonylurea or glinide.Our observation also demonstrated that glucose metabolism in autoimmune diabetes such as SPIDDM is influenced by appetite,thyroid function and glucocorticoid effect.
文摘Type 1 diabetes can be classified into immune-mediated diabetes (type 1A) and idiopathic diabetes, which lacks immunological evidence for beta cell autoimmunity (type 1B). Type 1A diabetes is characterized by the presence of the anti-glutamic acid decarboxylase antibody (anti-GADab). Fulminant type 1 diabetes is classified as type 1B diabetes, and characterized by the absence of anti-GADab, flu-like symptoms, and elevated serum exocrine pancreatic enzymes. We report a type 1 diabetic patient who showed flu-like symptoms, elevated serum exocrine pancreatic enzymes, and an extremely high-titer of anti-GADab, manifesting the characteristics of both type 1A and fulminant type 1 diabetes.
