Encephalitis and catatonia treated with ECT.
OBJECTIVE
To describe 2 cases of encephalitis with neuropsychiatric symptoms including catatonia, compounded by neuroleptic use for delirious agitation culminating in malignant catatonia responsive to electroconvulsive therapy (ECT).


BACKGROUND
Neuropsychiatric symptoms including catatonia can be manifestations of limbic encephalitis and encephalitides of unidentified etiology, including encephalitis lethargica. Catatonic features are often difficult to appraise in this context. This can easily lead to the use of neuroleptics, which may precipitate worsening of catatonia.


METHODS
Medical, neurologic, and psychiatric histories, physical examination findings, results of laboratory, imaging and neurophysiologic investigations, and treatment response with medications and ECT were recorded.


RESULTS
Both patients showed significant improvement with ECT.


CONCLUSIONS
Malignant catatonia can complicate encephalitis lethargica and idiopathic limbic encephalitis, which already carry high mortality rates. When neuroleptics are used for agitation in cases of encephalitis, physicians must be wary of precipitating malignant catatonia and neuroleptics should be discontinued when such a danger emerges. Although lorazepam is helpful in treating catatonia, it may not suffice, as in the cases presented. ECT deserves serious consideration early in the course of malignant catatonia and for catatonia nested in encephalopathy secondary to encephalitis, unresolved with lorazepam.
Ali
Sherese
S
Department of Neuropsychiatry, Toronto Western Hospital, Toronto, Ontario, Canada. sherese.ali@uhn.on.ca
Welch
Charles A
CA
Park
Lawrence T
LT
Pliakas
Andrea M
AM
Wilson
Amanda
A
Nicolson
Stephen
S
Huffman
Jeff
J
Fricchione
Gregory L
GL
D000328:Adult; D002389:Catatonia / Q000209:etiology / Q000628:therapy*; D002555:Cerebrospinal Fluid / Q000166:cytology; D004351:Drug Resistance; D004359:Drug Therapy, Combination; D004565:Electroconvulsive Therapy; D004569:Electroencephalography; D004660:Encephalitis / Q000209:etiology / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008218:Lymphocytosis / Q000134:cerebrospinal fluid; D008609:Mental Status Schedule; D009460:Neurologic Examination; D011595:Psychomotor Agitation / Q000209:etiology / Q000628:therapy; D011619:Psychotropic Drugs / Q000627:therapeutic use
D011619:Psychotropic Drugs