Co-occurrence of Anti-GAD65 Syndrome, Type 1 Diabetes Mellitus, and Focal Seizures With Impaired Awareness

Glutamic acid decarboxylase (GAD) is an intracellular enzyme found in the presynaptic end of nerve terminals that functions to synthesize ​​gamma-aminobutyric (GABA) via decarboxylation. Autoantibodies GAD65 isoform have been high levels neurological disorders including stiff person syndrome (SPS), autoimmune encephalitis, and refractory epilepsy. Low anti-GAD65 also noted type 1 diabetes mellitus. We present unusual case a woman with longstanding history focal seizures impaired awareness mellitus who was extremely titers clinical presentation suggestive syndrome. This highlights increasing significance etiologies within neurologic disorders, as well importance maintaining index suspicion for rare syndromes. Although uncommon unclear pathophysiology, we discuss establishing SPS diagnostic criteria facilitate timely diagnosis quickly direct patient management towards immunotherapy.