Abstract Details

Title Wearable Assessment of Gait in GAD65 Neurologic Autoimmunity

Topic Autoimmune Neurology

Presentation(s) S18 - Paraneoplastic Neurological Disorders, irAE, Stiff Person, IGLON5 (2:24 PM-2:36 PM)

Poster/Presentation
Number 008

Background GAD65 neurologic autoimmunity manifestations include stiff person spectrum disorder (SPSD), ataxia, and epilepsy. Seizure frequency and cognitive testing are used as outcome measures in epilepsy, but documenting functional changes in SPSD and ataxia is more challenging, complicating treatment decisions and outcome tracking in therapeutic trials.

Objective Analyze gait in GAD65 neurologic autoimmunity.

Design/Methods Patients with high-titer GAD65 antibodies and associated neurologic syndrome seen in the Mayo Autoimmune Neurology Clinic underwent timed 25-foot walk (T25FW) and gait analysis using APDM Opal devices on wrists, ankles, sternum, and lumbar spine.

Results Seventeen patients with GAD65 neurologic autoimmunity (median serum concentration 515 nmol/L [28.5 –1880]; CSF 1.5 nmol/L [ 0.65 – 12.8]) were included: 9 with SPSD, 6 with ataxia, and 2 with epilepsy (controls); 9/17 were female. Analysis was performed at median age 56 years (range 21 – 82), 49 months from diagnosis (0 – 344). T25FW was 9.3s (6.4 – 20.5) for SPSD, 14.8s (8.8 – 17.7) for ataxia, and 7.1 s (6.8 – 7.3; p=0.06) for epilepsy patients. Stride length was shorter in patients with ataxia (0.7 m [0.5-1.0]) relative to SPSD (0.9 m [0.6 – 1.2]) and epilepsy (1.1 m [1.1-1.2]). Double support time was highest in ataxia (34.3%, [27.0 – 41.8], p=0.02) compared to SPSD (23.4% [21.2 – 38.2]) and epilepsy (22.8% [22.5 – 23.2]). Toe off angle was lower in ataxia (24.7 degrees [14.2 – 31.2]) and SPSD (26.8 degrees [17.6 – 30.8]) relative to epilepsy (37.0 [35.0 – 39.0]). Coronal plane lumbar spine range of motion was reduced in those with SPSD (3.41 degrees, [2.0 – 5.3]) and ataxia (3.8 degrees [2.1 – 10.3]) compared to epilepsy (8.8 degrees [8.2 – 9.4]).

Conclusions Wearable gait analysis offers quantitative assessment of functional changes in GAD65-associated SPSD and ataxia. Longitudinal data are needed to identify metrics sensitive to treatment response and progression.

Authors/Disclosures
Samantha Banks, MD (Mayo Clinic) PRESENTER	Dr. Banks has nothing to disclose.
Charles L. Howe, PhD (Mayo Clinic)	Dr. Howe has received personal compensation for serving as an employee of Mayo Clinic. The institution of Dr. Howe has received research support from NIH/NINDS.
Sean J. Pittock, MD, FAAN (Mayo Clinic Dept of Neurology)	Dr. Pittock has received personal compensation in the range of $500-$4,999 for serving as a Consultant for UCB. Dr. Pittock has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Arialys Therapeutics. The institution of Dr. Pittock has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Alexion. Dr. Pittock has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Arialys. The institution of Dr. Pittock has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for UCB. The institution of Dr. Pittock has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Roche/Genentech. The institution of Dr. Pittock has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for Alexion/AstraZeneka. The institution of Dr. Pittock has received research support from NIH. The institution of Dr. Pittock has received research support from Alexion/AstraZeneka. The institution of Dr. Pittock has received research support from F. Hoffman/LaRoche/Genentech. Dr. Pittock has received intellectual property interests from a discovery or technology relating to health care. Dr. Pittock has received intellectual property interests from a discovery or technology relating to health care. Dr. Pittock has received publishing royalties from a publication relating to health care.
Andrew McKeon, MD (Mayo Clinic)	The institution of Dr. McKeon has received research support from National Institutes of Health. Dr. McKeon has received intellectual property interests from a discovery or technology relating to health care. Dr. McKeon has received intellectual property interests from a discovery or technology relating to health care. Dr. McKeon has received publishing royalties from a publication relating to health care.
Eoin P. Flanagan, MBBCh, FAAN (Mayo Clinic)	The institution of Dr. Flanagan has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Alexion. Dr. Flanagan has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Genentech. Dr. Flanagan has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Horizon Therapeutics. The institution of Dr. Flanagan has received personal compensation in the range of $10,000-$49,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Roche. Dr. Flanagan has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Pharmacy times. The institution of Dr. Flanagan has received personal compensation in the range of $5,000-$9,999 for serving on a Speakers Bureau for UCB. The institution of Dr. Flanagan has received research support from Viela Bio. The institution of Dr. Flanagan has received research support from UCB. The institution of Dr. Flanagan has received research support from Roche. Dr. Flanagan has received publishing royalties from a publication relating to health care. Dr. Flanagan has a non-compensated relationship as a Member of medical Advisory Board with The MOG Project that is relevant to AAN interests or activities. Dr. Flanagan has a non-compensated relationship as a Editorial board member with Journal of The Neurologic Sciences that is relevant to AAN interests or activities. Dr. Flanagan has a non-compensated relationship as a Editorial board member with Neuroimmunology Reports that is relevant to AAN interests or activities. Dr. Flanagan has a non-compensated relationship as a Editorial Board Member with Neurology, Neuroimmunology Neuroinflammation (N2) Journal that is relevant to AAN interests or activities.
Divyanshu Dubey, MD, FAAN (Mayo Clinic)	The institution of Dr. Dubey has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Argenx. The institution of Dr. Dubey has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Arialys. The institution of Dr. Dubey has received personal compensation in the range of $500-$4,999 for serving as a Consultant for UCB . Dr. Dubey has received research support from Department of Defense . Dr. Dubey has received research support from Department of Defense . Dr. Dubey has received research support from UCB. Dr. Dubey has received research support from David J. Tomassoni ALS Research Grant Program . Dr. Dubey has received intellectual property interests from a discovery or technology relating to health care. Dr. Dubey has received intellectual property interests from a discovery or technology relating to health care. Dr. Dubey has received intellectual property interests from a discovery or technology relating to health care. Dr. Dubey has received intellectual property interests from a discovery or technology relating to health care.
Cristina Valencia Sanchez, MD (Mayo Clinic Arizona)	Dr. Valencia Sanchez has a non-compensated relationship as a member of the medical advisory board with The MOG Project that is relevant to AAN interests or activities.
Smathorn Thakolwiboon, MD (Mayo Clinic Health System)	Dr. Thakolwiboon has nothing to disclose.
Jessica A. Sagen, MA (Mayo Clinic)	Ms. Sagen has nothing to disclose.
Farwa Ali, MD (Mayo Clinic)	Dr. Ali has nothing to disclose.
Anastasia Zekeridou, MD, PhD, FAAN (Neuroimmunology Laboratory, Mayo Clinic)	The institution of Dr. Zekeridou has received research support from Roche/Genentech. Dr. Zekeridou has received intellectual property interests from a discovery or technology relating to health care. Dr. Zekeridou has received intellectual property interests from a discovery or technology relating to health care. Dr. Zekeridou has received intellectual property interests from a discovery or technology relating to health care. Dr. Zekeridou has received intellectual property interests from a discovery or technology relating to health care.

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