关键词: 谷氨酸脱羧酶65, γ-氨基丁酸B型受体, 自身免疫性脑炎, 脑脊液, 脑电图

Abstract:

Objective： To analyze the clinical performance and diagnosis process of the autoimmune encephalitis （AE） patients with positive double antibodies in the cerebrospinal fluid（CSF）， and to provide the references for the diagnosis and treatment of such patients. Methods The clinical manifestations， magnetic resonance imaging （MRI） of the head， electroencephalogram （EEG）， CSF characteristics， and prognosis of one patient with AE positive for anti-glutamic acid decarboxylase （GAD） 65 and anti-γ-aminobutyric acid B receptor （GABA_BR） double antibodies in the CSF were retrospectively analyzed，and the literatures were reviewed. Results The patient was a 47-year-old male with subacute onset and progressively aggravated symptoms， mainly presenting with headaches and episodic convulsions， and blurred consciousness.The MRI results of the head suggested that the lesions were located on the right side of the cerebral falx in the frontal and parieto-occipital lobes；the CSF was positive for the anti-GAD65 and anti-GABA_BR double antibodies， and the EEG results showed the abnormal spike and slow waves， so the patient was diagnosed as AE. After anti-inflammatory and other symptomatic treatments， the patient was gradually improved and was discharged；the patient was given continuous oral corticosteroid treatment， but after 5 months， the patient was relapsed with acute onset， presenting with convulsion accompanied by drooling from the corner of the mouth. The head MRI results showed there was an abnormal high signal in the right temporal lobe. After corticosteroid treatment， the patient was improved. Conclusion The AE patients with positive double antibodies in CSF are more likely to relapse. Steroid anti-inflammatory treatment is effective. When intracranial lesions are located in the frontal and parieto-occipital lobes， it should be considered the possibility of symptoms such as convulsions. It is necessary to complete the EEG and the other inspections as soon as possible.

Key words: Glutamic acid decarboxylase 65, γ-aminobutyric acid B receptor, Autoimmune encephalitis, Cerebrospinal fluid, Electroencephalogram