# Perioperative Anesthetic and Hormonal Considerations in a Patient With Anti-glutamic Acid Decarboxylase Encephalitis: A Case Report

## TL;DR

A patient with anti-GAD encephalitis showed improvement after hormone suppression and surgery, but had seizure-like episodes post-surgery, highlighting the need for careful anesthetic and hormonal management.

## Contribution

This case report highlights the interplay between anti-GAD antibodies, general anesthetics, and hormonal treatments in managing autoimmune encephalitis.

## Key findings

- Suppression with Depo-Lupron and bilateral oophorectomy led to significant improvement in the patient's condition.
- Post-oophorectomy seizure-like episodes suggest a role for medication in modulating neuroexcitability.
- The case emphasizes the importance of interdisciplinary collaboration in perioperative management of autoimmune encephalitis.

## Abstract

Glutamic acid decarboxylase (GAD) is vital for gamma-aminobutyric acid (GABA) synthesis. Auto-antibodies against GAD deplete GAD levels and subsequently GABA, resulting in a hyper-excitatory state. A 41-year-old woman with anti-GAD encephalitis underwent bilateral oophorectomy for endometriosis. Despite treatments, the patient experienced limited improvement. Suppression with Depo-Lupron and subsequent bilateral oophorectomy resulted in significant improvement. Post-oophorectomy, she experienced seizure-like episodes, suggesting medication's role in modulating neuroexcitability. The case underscores the interplay between anti-GAD antibodies and general anesthetics, highlighting the importance of understanding perioperative management of autoimmune encephalitis. Research is needed for an optimal approach to this patient population, emphasizing interdisciplinary collaboration.