[Successful treatment of emotional disturbances following non-herpetic limbic encephalitis by serotonergic agents. A case report].
We report a 19-year-old woman who developed refractory status epilepticus due to non-herpetic limbic encephalitis. Because ordinary anti-epileptics were ineffective, general anesthesia under mechanical ventilation was begun with pentobarbital, midazolam, and propofol. After 4 months, we could finally discontinue the intravenous anesthetics. Then, she gradually became conscious and several weeks later, could communicate verbally. Simultaneously, she began to manifest psychomotor agitation and emotional incontinence mimicking Klüver-Bucy syndrome. Brain MRI revealed cortical atrophy in the fronto-temporal lobes and dilated anterior and inferior horns of the lateral ventricles. Dopamine blockers and benzodiazepines failed to resolve these emotional symptoms. Oral tandospirone (30 mg/day dose) was initiated and a partial regression was observed. The following administration of fluvoxamine (started with 12.5 mg/day and maintained with 75 mg/day) resulted in a dramatic improvement of her symptoms within 3 days. This clinical course suggests that impaired serotonergic neurotransmission plays a key role in her emotional disturbances and that its modulation by serotonergic agents is useful to relieve such symptoms.
Narikawa
K
K
Department of Neurology, Tohoku University School of Medicine.
Hasegawa
T
T
Takeda
A
A
Shiga
Y
Y
Itoyama
Y
Y
D000328:Adult; D000342:Affective Symptoms / Q000188:drug therapy* / Q000209:etiology; D005260:Female; D006801:Humans; D054833:Isoindoles; D020363:Limbic Encephalitis / Q000150:complications*; D010879:Piperazines / Q000627:therapeutic use*; D011743:Pyrimidines / Q000627:therapeutic use*; D017366:Serotonin Receptor Agonists / Q000627:therapeutic use*
D054833:Isoindoles; D010879:Piperazines; D011743:Pyrimidines; D017366:Serotonin Receptor Agonists; C055267:tandospirone