Anti-GAD65 antibody-associated cerebellar ataxia in a young adult with type 1 diabetes: a case report and literature review
Diabetology International, cilt.17, sa.4, 2026 (ESCI, Scopus)
- Yayın Türü: Makale / Tam Makale
- Cilt numarası: 17 Sayı: 4
- Basım Tarihi: 2026
- Doi Numarası: 10.1007/s13340-026-00920-7
- Dergi Adı: Diabetology International
- Derginin Tarandığı İndeksler: Emerging Sources Citation Index (ESCI), Scopus, EMBASE, Natural Science Collection (ProQuest), Biological Science Database (ProQuest), Health Research Premium Collection (ProQuest)
- Anahtar Kelimeler: Anti-glutamic acid decarboxylase antibodies, Autoimmune neurological disorder, Cerebellar ataxia, Type 1 diabetes
- Kocaeli Üniversitesi Adresli: Evet
Özet
Background: Anti-glutamic acid decarboxylase antibody-associated cerebellar ataxia (anti-GAD-CA) is a rare autoimmune neurological disorder. Although frequently associated with latent autoimmune diabetes in adults (LADA), it can occasionally coexist with type 1 diabetes mellitus (T1DM). Case: We report a 27-year-old woman with a 14-year history of T1DM who presented with subacute onset of balance impairment, vertigo, and hypophonic speech. Neurological examination and laboratory investigations were consistent with cerebellar ataxia. The patient exhibited high titers of anti–glutamic acid decarboxylase (anti-GAD) in both serum (619 IU/mL) and cerebrospinal fluid. Brain MRI was unremarkable. After a 5-day intravenous immunoglobulin (IVIG) therapy, the patient showed notable improvement in tandem gait and speech fluency. Her glycemic control also improved significantly, with the glycated hemoglobin (HbA1c) dropping from 9.7 to 6.8% over two months. Follow-up testing showed a steady decline in serum anti-GAD levels to 229 IU/mL. Conclusion: This case represents one of the youngest reported patients with anti-GAD-CA in the context of long-standing T1DM. The case emphasizes the importance of considering anti-GAD-CA in patients with unexplained cerebellar signs and autoimmune diabetes, even in younger individuals. Furthermore, the observed parallel improvements in neurological and glycemic parameters following immunotherapy may provide insight into the interplay between anti-GAD autoimmunity and metabolic control. Further studies are required to better understand the pathophysiological mechanisms and optimize management strategies.