A Case of Anti-NMDA Receptor Encephalitis Treated with ECT

Journal of Psychiatric Practice
Kristin C JonesDavid A Kahn

Abstract

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.

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Citations

Oct 3, 2015·Asian Journal of Psychiatry·Dirk Dhossche, Charles H Kellner
Dec 17, 2019·Journal of Clinical Psychopharmacology·Jesús Ramirez-BermudezMariana Espinola-Nadurille
Nov 9, 2016·Harvard Review of Psychiatry·Aaron J Hauptman, Sheldon Benjamin
Feb 20, 2019·Pediatric Rheumatology Online Journal·Taha MoussaLinda Wagner-Weiner
Feb 11, 2020·Frontiers in Neurology·Wei WangJin-Mei Li
Aug 13, 2017·Current Psychiatry Reports·Nasuh MalasSusan Turkel
Oct 31, 2019·CNS Spectrums·Inês Marques Macedo, João Gama Marques
Oct 15, 2019·Pediatric Annals·Karyn GerstleTaha Moussa
Apr 25, 2020·Biomedical Journal·Kuang-Lin Lin, Jann-Jim Lin

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