Fig. 1.

N-acetyl aspartate to creatine ratio (NAA/Cr) of the vermis showing alterations in relation to different treatment interventions. The patient developed ataxia in 1996, but the diagnosis of anti-GAD ataxia was not made until 2003. She followed a benign course initially. She did receive 3 courses of intravenous immunoglobulins in 2005 with no evidence of clinical benefit. Whilst there was evidence of significant improvement of the MR spectroscopy with subsequent interventions (from 2011 onwards, when MR spectroscopy became available), the patient did not feel that there was a dramatic clinical improvement of the ataxia and was reluctant to continue such treatments. She now has severe ataxia with disabling cerebellar tremor