Duolingo-induced seizures in GAD65 IgG associated autoimmune epilepsy

• Reflex seizures are seizures that are consistently triggered by a specific, identifiable stimulus. • Musicogenic seizures are the most commonly reported reflex seizures in GAD65 antibody associated epilepsy • Nonmusicogenic acoustic seizures can also occur in association with GAD65 antibodiy associated epilepsy. • The presence of musicogenic or audiogenic reflex seizures should warrant careful consideration for evaluation of GAD65 antibody association. Autoimmune etiologies of seizures have been increasingly recognized with the discovery of novel autoantibodies to cell surface and intracellular antigens. GAD65 neurologic autoimmunity has been associated with stiff person syndrome, cerebellar ataxia, and chronic focal epilepsy, usually of temporal regional origin. While musicogenic reflex seizures have been described in multiple GAD65 IgG seropositive patients, non-musicogenic acoustic reflex seizures have not been described. We present a case of a patient with GAD65 antibody associated epilepsy with a long-standing history of right temporal seizures who developed left temporal reflex seizures triggered by a specific character and language while using the language learning app, Duolingo.