Polyglandular autoimmune syndrome type 4 with GAD antibody and dystonia

[...]the antibodies may generate an inflammatory vasculopathy in cerebral vessels, resulting in transient or permanent ischemic injury to the basal ganglia. [...]neuronal dysfunction may result from antibody binding onto the basal ganglia neurons. [...]only left hand grip can enhance the activities of the ipsilateral basal ganglia (Fig. 1C, hand grip). Since hand grip is a simple movement that usually requires only activities of the contralateral motor-sensory cortex and ipsilateral cerebellum, the enhancement of the left basal ganglia activities may suggest the preponderance of functional perturbation of the left cortico-basal ganglia circuitry during the performance of simple motor tasks.