A Case of Anti-NMDA Receptor Encephalitis Treated with ECT.
We describe the case of a 17-year-old male who presented with acute onset of seizures and malignant catatonia with psychosis, agitation, and hypermetabolism, who responded to electroconvulsive therapy (ECT). Soon after he began to respond, he was diagnosed with anti-N-methyl-D-aspartate (NMDA) receptor encephalitis and then given immunosuppressive therapy. Anti-NMDA receptor encephalitis is an increasingly recognized autoimmune disorder that often presents with neuropsychiatric symptoms. The mainstays for treatment have been early diagnosis, tumor work-up and removal if found, and initiation of immunosuppressive therapy. Treatment response is often slow and residual symptoms common. In this case, ECT produced clinical stabilization before the underlying diagnosis of anti-NMDA receptor encephalitis was made and standard treatment initiated. We suggest that ECT may be highly beneficial for stabilizing life-threatening neuropsychiatric symptoms in this syndrome and should be considered as a potentially additive treatment to immunotherapy when rapid relief is sought.
JONES: Baylor College of Medicine, Houston, TX SCHWARTZ and HERMIDA: Emory University School of Medicine, Atlanta GA KAHN: Columbia University College of Physicians and Surgeons, New York, NY.
Kristin C
KC
Jones
Ann C
AC
Schwartz
Adriana P
AP
Hermida
David A
DA
Kahn
D000293:Adolescent; D060426:Anti-N-Methyl-D-Aspartate Receptor Encephalitis / Q000503:physiopathology / Q000628:therapy*; D004565:Electroconvulsive Therapy / Q000379:methods*; D006801:Humans; D008297:Male