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To the Editor:
The recent study by Nemni et al.1 reporting high autoantibodies to glutamic acid decarboxylase (anti-GAD65) antibody titers in a mother with stiff-person syndrome (SPS) and in her two asymptomatic children is of special interest. Recently, we reported a similar experience in a symptomatic mother and her asymptomatic infant.2 In our family, the mother (and grandfather) had symptomatic SPS with markedly elevated GAD65 antibodies, whereas the infant was asymptomatic in spite of elevated GAD65 antibody titers. The baby's antibody titers dropped markedly during the first year of life (72.7 nmol/L at birth, 6.65 nmol/L at 3 months, 0.65 nmol/L at 7 months). This suggested transplacental passage of antibodies.
We felt that the absence of abnormal neurologic symptoms or signs in the infant suggested that GAD65 antibodies may lack pathogenicity and rather be a biomarker, as has been demonstrated with the type 1 Purkinje cell cytoplasmic antibody marker of cerebellar ataxia.3 …
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