Anti-GAD antibody-associated epilepsy in pregnancy

Anti-GAD antibody-associated epilepsy (AAE) is a rare neurological condition arising as a consequence of autoantibodies against the intracellular antigen glutamic acid decarboxylase (GAD) 65. It most commonly manifests in women of childbearing age, with persistent seizures, often refractory to therapy. Here described is a woman in her first pregnancy, with anti-GAD AAE, managed in pregnancy with a combination of anti-seizure medications (ASM) and intravenous immunoglobulin. Escalation of her medication doses was required as her pregnancy progressed in response to falling ASM levels and increased seizure frequency. She delivered a healthy neonate following induction of labour at 38 weeks’ gestation due to intrahepatic cholestasis, potentially related to azathioprine use. Early neonatal anti-GAD antibody testing and baseline neurological examination were undertaken with developmental follow-up planned, given the uncertain significance of passively transferred maternal antibodies.