Acute Rehabilitation to Address Impairments Related to Autoimmune Glial Fibrillary Acidic Protein (GFAP) Meningo-encephalo-myelitis: A Case Study

Case Diagnosis: Autoimmune anti-GFAP-antibody meningo-encephalo-myelitis

Case Description or Program Description: A 34-year-old man with well-controlled ulcerative colitis presented with rapidly progressing meningitis symptoms. He stabilized hemodynamically with initial treatment, but over the next three weeks he developed vision changes (right CN II and bilateral CN VI dysfunction), tremors, ataxia, urinary retention, orthostatic hypotension, and electrolyte imbalances. After nearly a month in the hospital, he was diagnosed with autoimmune meningo-encephalo-myelitis, with a positive CSF anti-glial fibrillary antibody protein (GFAP) antibody. He was admitted to the ARU with profound debility and weakness. He was dependent for all ADLs and cares. He required a ceiling lift for transfers and was unable to feed himself.

Setting: Acute Inpatient Rehabilitation Unit (ARU)

Assessment/Results: He responded to high dose steroids. Additional treatment included midodrine for orthostatic hypotension, potassium chloride for hypokalemia, and intermittent catheterization for neurogenic bladder. He participated in interdisciplinary therapies. Sessions were tailored to current status. Over his six-week course, he progressed to sitting, then standing, then ambulating, to the point where he could walk steadily with a hand-held cane. Despite residual visuomotor problems, he became independent with self-cares. He was discharged home with his family.

Discussion (relevance): Anti-GFAP-antibody meningo-encepho-myelitis is an immune-mediated encephalitis syndrome. It has been recognized as a distinct clinical entity since 2016, when testing for the antibody became available. The exact etiology is unknown, but autoimmune pathology appears to be a prominent factor. There are only a handful of diagnosed cases per year. It is likely that more cases will be diagnosed as knowledge about the condition spreads.

Conclusions: To our knowledge, this is the first description of acute rehabilitation for someone with severe impairments related to autoimmune anti-GFAP-antibody meningo-encephalo-myelitis. The case demonstrates that interdisciplinary care and therapies were safe and effective. Additional information about strategies aimed at optimizing recovery and rehabilitation would be helpful.