title: The effect of ropinirole on apathy and depression after herpes encephalitis.
abstract: We describe a 76-year-old man with herpes encephalitis whose symptom of severe apathy was improved by the dopamine D2/D3 receptor agonist ropinirole. Brain magnetic resonance imaging had shown lesions in the patient's right mesial temporal cortex, right insula, and bilateral medial frontal regions. During treatment with acyclovir, he had developed severe apathy and depression. On neuropsychological assessment, he scored 21/30 points on the Mini-Mental State Examination, 30/42 on the Starkstein Apathy Scale (cutoff score =16), and 59/80 on the Zung Self-Rating Depression Scale (cutoff score=40). We then started him on ropinirole 0.25 mg/day. Over the next 10 days, his apathy and depression gradually improved. On day 10 of treatment, follow-up testing showed that his Apathy Scale score had improved to 25 points. This case suggests that a low dose of a dopamine receptor agonist may be an effective treatment for patients who develop apathy and depression after encephalitis.
authors.affiliation: Department of Neurology, Shimane Prefectural Central Hospital, Himebara, Izumo, Japan. kohnonaoto@gmail.com
authors.forename: Naoto
authors.initials: N
authors.lastname: Kohno
authors.forename: Yoko
authors.initials: Y
authors.lastname: Nabika
authors.forename: Genya
authors.initials: G
authors.lastname: Toyoda
authors.forename: Hirokazu
authors.initials: H
authors.lastname: Bokura
authors.forename: Tomoko
authors.initials: T
authors.lastname: Nagata
authors.forename: Shuhei
authors.initials: S
authors.lastname: Yamaguchi
mesh_terms: D000368:Aged; D057565:Apathy / Q000187:drug effects*; D001921:Brain / Q000098:blood supply / Q000473:pathology; D003863:Depression / Q000188:drug therapy*; D018491:Dopamine Agonists / Q000627:therapeutic use*; D020803:Encephalitis, Herpes Simplex / Q000175:diagnosis / Q000188:drug therapy*; D005500:Follow-Up Studies; D006801:Humans; D007211:Indoles / Q000008:administration & dosage / Q000627:therapeutic use*; D008297:Male; D009483:Neuropsychological Tests; D011569:Psychiatric Status Rating Scales
chemical_list: D018491:Dopamine Agonists; D007211:Indoles; C046649:ropinirole