Disabling Central Paroxysmal Positioning Upbeat Nystagmus and Vertigo Associated With the Presence of Anti-Glutamic Acid Decarboxylase Antibodies

Download item | Update item information
Title Disabling Central Paroxysmal Positioning Upbeat Nystagmus and Vertigo Associated With the Presence of Anti-Glutamic Acid Decarboxylase Antibodies
Creator Ana I. Martins; João N. Carvalho; Ana M. Amorim; Argemiro; Geraldo; Eric Eggenberger; João Lemos
Affiliation Departments of Neurology (AIM, JNC, AG, JL) and Otorhinolaryngology (AMA), Coimbra University Hospital Centre, Coimbra, Portugal; and Department of Neurology and Ophthalmology (EE), Michigan State University, East Lansing, Michigan.
Subject Central Paroxysmal; Upbeat Nystagmus; Vertigo; Anti-Glutamic Acid Decarboxylase Antibodies
Abstract An immune attack by anti-glutamic acid decarboxylase (GAD) antibodies is believed to cause a deficiency in gamma-aminobutyric acid-mediated neurotransmission in the cerebellum. This, in turn, leads to several eye movement disorders, including spontaneous downbeat (DBN) and periodic alternating nystagmus. We describe a 68-year-old diabetic woman with disabling paroxysmal positioning upbeat nystagmus (UBN) exclusively in the supine position, associated with asymptomatic spontaneous DBN, alternating skew deviation and hyperactive vestibulo-ocular reflex responses on head impulse testing, in whom high titers of anti-GAD antibodies were detected. After treatment with intravenous immunoglobulin, a complete resolution of positioning UBN and spontaneous DBN occurred, along with a decrease in anti-GAD antibody titers. Positioning UBN in this case may reflect a transient disinhibition of the central vestibular pathways carrying posterior semicircular canal signals, due to lack of normal inhibitory input from the cerebellar nodulus/uvula. Immunoglobulin restored cerebellar inhibitory output, possibly by improving gamma-aminobutyric acid neurotransmission.
OCR Text Show
Publisher Lippincott, Williams & Wilkins
Date 2018-03
Type Text
Source Journal of Neuro-Ophthalmology, December 2018, Volume 38, Issue 1
Language eng
Rights Management © North American Neuro-Ophthalmology Society
Publication Type Journal Article
ARK ark:/87278/s6j14gc2
Setname ehsl_novel_jno
Date Created 2019-03-11
Date Modified 2019-03-11
ID 1404049
Reference URL https://collections.lib.utah.edu/ark:/87278/s6j14gc2
Back to Search Results