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Wright MA, Guasp M, Lachner C, Day GS, Gombolay G, Titulaer MJ, Clardy SL. Electroconvulsive therapy in N-methyl-d-aspartate receptor encephalitis: A retrospective cohort and scoping review of literature. J Neuroimmunol 2024; 392:578369. [PMID: 38823118 DOI: 10.1016/j.jneuroim.2024.578369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2024] [Revised: 05/04/2024] [Accepted: 05/12/2024] [Indexed: 06/03/2024]
Abstract
Neuropsychiatric symptoms in N-methyl-d-aspartate receptor encephalitis (NMDARE) have led some to pursue empiric trials of electroconvulsive therapy (ECT). A scoping review identified 39 patients diagnosed with NMDARE undergoing ECT. Separately, a retrospective cohort was reviewed to characterize 21 patients. Clinical improvement was attributed to ECT in 49% of patients in the scoping review and 19% of patients in the retrospective cohort; timing of immunotherapies was a confounding factor. Worsening of clinical course following ECT was reported in 28% of patients in the scoping review and 38% of patient in the retrospective review. There is currently insufficient data supporting a beneficial effect of ECT in NMDARE.
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Affiliation(s)
- Melissa A Wright
- Division of Pediatric Neurology, Department of Pediatrics, University of Utah, Salt Lake City, UT, USA.
| | - Mar Guasp
- Service of Neurology, Hospital Clínic, University of Barcelona, Spain; Neuroimmunology Program, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Christian Lachner
- Division of Psychiatry, Mayo Clinic, Jacksonville, FL, USA; Department of Neurology, Mayo Clinic, Jacksonville, FL, USA
| | - Gregory S Day
- Department of Neurology, Mayo Clinic, Jacksonville, FL, USA
| | - Grace Gombolay
- Emory University School of Medicine, Children's Healthcare of Atlanta, Department of Pediatrics, Division of Neurology, Atlanta, GA, USA
| | - Maarten J Titulaer
- Department of Neurology, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Stacey L Clardy
- Department of Neurology, University of Utah, Salt Lake City, UT, USA; George E. Wahlen Veterans Affairs Health Care System, Salt Lake City, UT, USA
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2
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Connell J, Oldham M, Pandharipande P, Dittus RS, Wilson A, Mart M, Heckers S, Ely EW, Wilson JE. Malignant Catatonia: A Review for the Intensivist. J Intensive Care Med 2023; 38:137-150. [PMID: 35861966 DOI: 10.1177/08850666221114303] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Catatonia is a clinical syndrome characterized by psychomotor, neurological and behavioral changes. The clinical picture of catatonia ranges from akinetic stupor to severe motoric excitement. Catatonia can occur in the setting of a primary psychiatric condition such as bipolar disorder or secondary to a general medical illness like autoimmune encephalitis. Importantly, it can co-occur with delirium or coma. Malignant catatonia describes catatonia that presents with clinically significant autonomic abnormalities including change in temperature, blood pressure, heart rate, and respiratory rate. It is a life-threatening form of acute brain dysfunction that has several motoric manifestations and occurs secondary to a primary psychiatric condition or a medical cause. Many of the established predisposing and precipitating factors for catatonia such as exposure to neuroleptic medications or withdrawal states are common in the setting of critical illness. Catatonia typically improves with benzodiazepines and treatment of its underlying psychiatric or medical conditions, with electroconvulsive therapy reserved for catatonia refractory to benzodiazepines or for malignant catatonia. However, some forms of catatonia, such as catatonia secondary to a general medical condition or catatonia comorbid with delirium, may be less responsive to traditional treatments. Prompt recognition and treatment of catatonia are crucial because malignant catatonia may be fatal without treatment. Given the high morbidity and mortality associated with malignant catatonia, intensivists should familiarize themselves with this important and under-recognized condition.
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Affiliation(s)
- Jennifer Connell
- Critical Illness, Brain Dysfunction, and Survivorship (CIBS) Center, Nashville, TN, USA.,12327Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Mark Oldham
- University of Rochester Medical Center, Rochester, NY, USA
| | - Pratik Pandharipande
- Critical Illness, Brain Dysfunction, and Survivorship (CIBS) Center, Nashville, TN, USA.,Division of Critical Care Medicine, Department of Anesthesiology, 12328Vanderbilt University Medical Center, Nashville, TN, USA
| | - Robert S Dittus
- Critical Illness, Brain Dysfunction, and Survivorship (CIBS) Center, Nashville, TN, USA.,Veterans Health Administration-Tennessee Valley Healthcare System Geriatric Research, Education and Clinical Center (GRECC), Nashville, TN, USA.,Division of General Internal Medicine and Public Health, Department of Medicine, 12328Vanderbilt University Medical Center, Nashville, TN, USA
| | - Amanda Wilson
- Department of Psychiatry and Behavioral Sciences, 12328Vanderbilt University Medical Center, Nashville, TN, USA
| | - Matthew Mart
- Critical Illness, Brain Dysfunction, and Survivorship (CIBS) Center, Nashville, TN, USA.,Veterans Health Administration-Tennessee Valley Healthcare System Geriatric Research, Education and Clinical Center (GRECC), Nashville, TN, USA.,Division of Allergy, Pulmonary, and Critical Care Medicine, Department of Medicine, 12328Vanderbilt University Medical Center, Nashville, TN, USA
| | - Stephan Heckers
- Critical Illness, Brain Dysfunction, and Survivorship (CIBS) Center, Nashville, TN, USA.,Department of Psychiatry and Behavioral Sciences, 12328Vanderbilt University Medical Center, Nashville, TN, USA
| | - E Wes Ely
- Critical Illness, Brain Dysfunction, and Survivorship (CIBS) Center, Nashville, TN, USA.,Veterans Health Administration-Tennessee Valley Healthcare System Geriatric Research, Education and Clinical Center (GRECC), Nashville, TN, USA.,Division of Allergy, Pulmonary, and Critical Care Medicine, Department of Medicine, 12328Vanderbilt University Medical Center, Nashville, TN, USA
| | - Jo Ellen Wilson
- Critical Illness, Brain Dysfunction, and Survivorship (CIBS) Center, Nashville, TN, USA.,Veterans Health Administration-Tennessee Valley Healthcare System Geriatric Research, Education and Clinical Center (GRECC), Nashville, TN, USA.,Department of Psychiatry and Behavioral Sciences, 12328Vanderbilt University Medical Center, Nashville, TN, USA
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3
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Tanguturi YC, Hanzlik E, Pagano L, Cundiff AW, Graham TB, Fuchs DC. Anti-NMDAR Encephalitis: Multidisciplinary Development of a Clinical Practice Guideline. Hosp Pediatr 2021; 11:1295-1302. [PMID: 34642216 DOI: 10.1542/hpeds.2021-005882] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Yasas C Tanguturi
- Division of Child and Adolescent Psychiatry, Department of Psychiatry and Behavioral Sciences
| | | | | | - Allyson Witters Cundiff
- Division of Child and Adolescent Psychiatry, Department of Psychiatry and Behavioral Sciences
| | | | - D Catherine Fuchs
- Division of Child and Adolescent Psychiatry, Departments of Psychiatry and Behavioral Sciences and Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee
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4
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Gralewicz A, Świȩcicki Ł, Antosik-Wójcińska AZ, Konopko M, Kurkowska-Jastrzȩbska I, Sienkiewicz-Jarosz H, Szostakiewicz Ł, Remberk B. ECT in an Adolescent With Schizophrenia and Seizures: Case Report. Front Psychiatry 2021; 12:646466. [PMID: 34867497 PMCID: PMC8633535 DOI: 10.3389/fpsyt.2021.646466] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Accepted: 09/22/2021] [Indexed: 11/13/2022] Open
Abstract
Electroconvulsive therapy (ECT) has been recognized as an effective treatment option in catatonia, and for prolonged or severe affective episodes and schizophrenia. Response rates vary from 40 to 80% in adolescents. The procedure is safe if the required precautions are undertaken. Nonetheless, ECT remains a serious clinical challenge in patients with comorbid seizures. We present a case study of a 17-year-old female student suffering from schizophrenia who was scheduled for ECT due to prior treatment inefficacy. Seizures had occurred a few days before the first ECT session. Nevertheless, the patient received the ECT course, combined with clozapine at 125 mg/day, after neurological diagnosis and treatment modification because the illness became life-threatening. The patient's clinical outcome was satisfactory without any seriously adverse events and further improvements were observed in the mental state following long-term psychosocial treatment at our inpatient unit. A few months later, epilepsy was however diagnosed with probably coexistence of partial seizures and seizure-like events without EEG correlate. Administering ECT in patients with seizure comorbidity was also investigated based on previous research. Data on this is, however, extremely scarce and to the best of our knowledge, the safety and efficacy of using ECT in adolescents with schizophrenia and seizures has yet not to any great extent been discussed in the literature.
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Affiliation(s)
- Anna Gralewicz
- Child and Adolescent Psychiatry Department, Institute of Psychiatry and Neurology (IPiN), Warsaw, Poland
| | - Łukasz Świȩcicki
- Second Psychiatry Department, Institute of Psychiatry and Neurology (IPiN), Warsaw, Poland
| | | | - Magdalena Konopko
- First Neurology Department, Institute of Psychiatry and Neurology (IPiN), Warsaw, Poland
| | | | | | - Łukasz Szostakiewicz
- Child and Adolescent Psychiatry Department, Institute of Psychiatry and Neurology (IPiN), Warsaw, Poland
| | - Barbara Remberk
- Child and Adolescent Psychiatry Department, Institute of Psychiatry and Neurology (IPiN), Warsaw, Poland
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Abstract
Anti-N-methyl-D-aspartate receptor (NMDAr) encephalitis is a relatively recent autoimmune entity, as it was first described in 2007. Given that it is a condition with neuropsychiatric symptoms, its initial symptom is frequently psychiatric in nature. Hence, psychiatrists are often the first physicians to assess these patients and, as so, must recognize this type of encephalitis as a possible cause. Catatonia may be inaugural or develop throughout the course of the disease. Management of patients with anti-NMDAr encephalitis is based on etiologic treatment with immunotherapy and removal of the associated tumor, if any. However, these catatonic patients may have variable responses to etiologic treatment, sometimes with refractory catatonic symptoms, which attests to the necessary urgency to know how to manage these patients. In the clinical setting, physicians appear to be using guidelines originally created to the management of catatonia due to primary psychiatric conditions. In this literature review, catatonia was historically contextualized and anti-NMDAr encephalitis overall described. Finally, catatonia secondary to this type of encephalitis was discussed.
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Stein ALS, Sacks SM, Roth JR, Habis M, Saltz SB, Chen C. Anesthetic Management During Electroconvulsive Therapy in Children. Anesth Analg 2020; 130:126-140. [DOI: 10.1213/ane.0000000000004337] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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7
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Huang Q, Xie Y, Hu Z, Tang X. Anti-N-methyl-D-aspartate receptor encephalitis: A review of pathogenic mechanisms, treatment, prognosis. Brain Res 2019; 1727:146549. [PMID: 31726044 DOI: 10.1016/j.brainres.2019.146549] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Revised: 11/08/2019] [Accepted: 11/09/2019] [Indexed: 02/06/2023]
Abstract
Anti-N-methyl-D-aspartate receptor (anti-NMDAR) encephalitis is a treatable autoimmune disorder characterized by prominent neuropsychiatric symptoms that predominantly affects children and young adults. In this review, we discuss the pathogenic mechanisms and immunologic triggers of anti-NMDAR encephalitis, and provide an overview of treatment and prognosis of this disorder, with specific focus on the management of common symptoms, complications, and patients during pregnancy. Most patients respond well to first-line treatment and surgical resection of tumors. When first-line immunotherapy fails, second-line immunotherapy can often improve outcomes. In addition, treatment with immunomodulators and tumor resection are effective treatment strategies for pregnant patients. Benzodiazepines are the preferred treatment for patients with catatonia, and electroconvulsive therapy (ECT) may be considered when pharmacological treatment is ineffective. Age, antibody titer, cerebellar atrophy, levels of biomarkers such as C-X-C motif chemokine 13 (CXCL13), cell-free mitochondrial (mt)DNA in cerebral serum fluid (CSF), and timing from symptom onset to treatment are the main prognostic factors. Patients without tumors or those who receive insufficient immunotherapy during the first episode are more likely to relapse.
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Affiliation(s)
- Qianyi Huang
- Department of Neurology, The Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, China
| | - Yue Xie
- Department of Neurology, The Xiangya Hospital, Central South University, Changsha, Hunan 410011, China
| | - Zhiping Hu
- Department of Neurology, The Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, China
| | - Xiangqi Tang
- Department of Neurology, The Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, China.
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Warren N, Grote V, O'Gorman C, Siskind D. Electroconvulsive therapy for anti-N-methyl-d-aspartate (NMDA) receptor encephalitis: A systematic review of cases. Brain Stimul 2019; 12:329-334. [DOI: 10.1016/j.brs.2018.11.016] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Revised: 11/15/2018] [Accepted: 11/30/2018] [Indexed: 11/27/2022] Open
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Dhossche DM, Withane N. Electroconvulsive Therapy for Catatonia in Children and Adolescents. Child Adolesc Psychiatr Clin N Am 2019; 28:111-120. [PMID: 30389071 DOI: 10.1016/j.chc.2018.07.007] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Catatonia may be more common in children and adolescents than previously thought. A boost for the recognition of pediatric catatonia comes from changes in Diagnostic and Statistical Manual of Mental Disorders, 5th edition, facilitating the diagnosis in a wide range of pediatric and adult patients with associated developmental and autistic spectrum disorders; and schizophrenic, affective, and medical disorders. The current status, assessment, and treatment of pediatric catatonia are described. Two case vignettes illustrate diagnostic assessment and treatment. Theories modeling the mechanism of catatonia are reviewed, including a vagal theory.
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Affiliation(s)
- Dirk M Dhossche
- Department of Psychiatry, University of Mississippi Medical Center, 2500 North State Street, Jackson, MS 39216, USA.
| | - Nisha Withane
- Department of Psychiatry, Institute of Living/Hartford Hospital, 200 Retreat Avenue, Hartford, CT 06114, USA
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10
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Psychiatric manifestations and psychopharmacology of autoimmune encephalitis: A multidisciplinary approach. PSYCHOPHARMACOLOGY OF NEUROLOGIC DISEASE 2019; 165:285-307. [DOI: 10.1016/b978-0-444-64012-3.00017-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
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11
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Tanguturi YC, Cundiff AW, Fuchs C. Anti-N-Methyl d-Aspartate Receptor Encephalitis and Electroconvulsive Therapy: Literature Review and Future Directions. Child Adolesc Psychiatr Clin N Am 2019; 28:79-89. [PMID: 30389078 DOI: 10.1016/j.chc.2018.07.005] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Despite the majority of patients with anti-N-methyl d-aspartate receptor (NMDAR) antibody encephalitis presenting with catatonic symptoms, the literature has not focused on well-known treatments for catatonia, such as electroconvulsive therapy (ECT). The authors review the literature identifying case reports that document the effective use of ECT for anti-NMDAR encephalitis. They also identify gaps in the literature regarding use and documentation of ECT and review possible mechanisms of action for ECT. The authors propose identifying catatonia as a syndrome with multiple potential causes (including anti-NMDAR encephalitis) and suggest a standardized treatment approach using evidence-based catatonia treatments such as ECT and benzodiazepines.
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Affiliation(s)
| | | | - Catherine Fuchs
- Village at Vanderbilt, Suite 2200, 1500 21st Avenue South, Nashville, TN 37212, USA.
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12
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Benarous X, Raffin M, Ferrafiat V, Consoli A, Cohen D. Catatonia in children and adolescents: New perspectives. Schizophr Res 2018; 200:56-67. [PMID: 28754582 DOI: 10.1016/j.schres.2017.07.028] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Revised: 07/06/2017] [Accepted: 07/09/2017] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Catatonia is a rare and severe psychomotor condition in children and adolescents. In the current report, we aimed to review the recent literature. METHOD Using a PRISMA approach, we searched MEDLINE between 1982 and 2017 using the keywords 'CATATONIA' and 'CHILD' or 'ADOLESCENT'. In total, we reviewed 130 reports (controlled study, N=4; clinical chart, N=23; case report, N=54; and editorial/review, N=42). RESULTS Several aspects seem to be age specific: (1) although the clinical presentation resembles that in adults, some symptoms are important in children and adolescents (e.g., psychomotor regression). (2) Associated disorders are similar to that found in adults; however, schizophrenia is more frequently observed than mood disorder. Additionally, a history of neurodevelopmental disorders maybe encountered. (3) Morbidity and mortality are among the worst in child psychiatry. (4) Underlying organic conditions are highly prevalent (>20% of the cases), and their search is warranted because some diagnoses may result in specific treatments (e.g., immune-suppressor therapy for autoimmune conditions). (5) Symptomatic approaches - high dose of benzodiazepines and electroconvulsive therapy (ECT) - are as efficient in children or adolescents as they are in adults, but this finding needs to be acknowledged because a resistance against the use of ECT or high-dose medication exists among child psychiatrists. DISCUSSION Recent advances in child and adolescent catatonia research have offered major improvements in understanding catatonia and in new therapeutic opportunities. The syndrome is rare, but these advances need to be acknowledged in order to direct patients to centers that have developed a specific expertise.
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Affiliation(s)
- Xavier Benarous
- Department of Child and Adolescent Psychiatry, Pitié-Salpêtrière Hospital, Paris, France; GRC-15, Dimensional Approach of Child and Adolescent Psychotic Episodes, Faculté de Médecine, UPMC, Paris, France.
| | - Marie Raffin
- Department of Child and Adolescent Psychiatry, Pitié-Salpêtrière Hospital, Paris, France; GRC-15, Dimensional Approach of Child and Adolescent Psychotic Episodes, Faculté de Médecine, UPMC, Paris, France
| | - Vladimir Ferrafiat
- Department of Child and Adolescent Psychiatry, CHU Charles Nicolle, Rouen, France
| | - Angèle Consoli
- Department of Child and Adolescent Psychiatry, Pitié-Salpêtrière Hospital, Paris, France; GRC-15, Dimensional Approach of Child and Adolescent Psychotic Episodes, Faculté de Médecine, UPMC, Paris, France
| | - David Cohen
- Department of Child and Adolescent Psychiatry, Pitié-Salpêtrière Hospital, Paris, France; CNRS UMR 7222, Institute for Intelligent Systems and Robotics, Sorbonnes Universités, UPMC, Paris, France
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Constantinides VC, Kasselimis DS, Paraskevas GP, Zacharopoulou M, Andreadou E, Evangelopoulos ME, Kapaki E, Kilidireas C, Stamboulis E, Potagas C. Anti-NMDA receptor encephalitis presenting as isolated aphasia in an adult. Neurocase 2018; 24:188-194. [PMID: 30293488 DOI: 10.1080/13554794.2018.1524915] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Anti-NMDA receptor (NMDA-r) encephalitis is a relatively rare cause of autoimmune encephalitis with divergent clinical presentations. We report a case of an adult patient with anti-NMDA-r encephalitis presenting with isolated, abrupt-onset aphasia. Her condition remained unaltered over a period of 6 months. The patients' electroencephalogram findings were typical for NMDA-r encephalitis; however, her magnetic resonance imaging and cerebrospinal fluid analysis were normal. She responded well to immunotherapy, and aphasia eventually resolved. The natural course of the present case contradicts the rapidly progressive nature of typical NMDA-r encephalitis. Furthermore, it broadens the clinical spectrum of anti-NMDA-r encephalitis, to incorporate isolated, nonprogressive aphasia.
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Affiliation(s)
- Vasilios C Constantinides
- a 1st Department of Neurology , National and Kapodistrian University of Athens, Eginition Hospital , Athens , Greece
| | - Dimitrios S Kasselimis
- a 1st Department of Neurology , National and Kapodistrian University of Athens, Eginition Hospital , Athens , Greece.,b Department of Psychiatry , School of Medicine, University of Crete , Heraklion , Greece
| | - George P Paraskevas
- a 1st Department of Neurology , National and Kapodistrian University of Athens, Eginition Hospital , Athens , Greece
| | - Maria Zacharopoulou
- a 1st Department of Neurology , National and Kapodistrian University of Athens, Eginition Hospital , Athens , Greece
| | - Elisabeth Andreadou
- a 1st Department of Neurology , National and Kapodistrian University of Athens, Eginition Hospital , Athens , Greece
| | | | - Elisabeth Kapaki
- a 1st Department of Neurology , National and Kapodistrian University of Athens, Eginition Hospital , Athens , Greece
| | - Costas Kilidireas
- a 1st Department of Neurology , National and Kapodistrian University of Athens, Eginition Hospital , Athens , Greece
| | - Eleftherios Stamboulis
- a 1st Department of Neurology , National and Kapodistrian University of Athens, Eginition Hospital , Athens , Greece
| | - Constantin Potagas
- a 1st Department of Neurology , National and Kapodistrian University of Athens, Eginition Hospital , Athens , Greece
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[German version of the Northoff catatonia rating scale (NCRS-dv) : A validated instrument for measuring catatonic symptoms]. DER NERVENARZT 2018; 88:787-796. [PMID: 27325247 DOI: 10.1007/s00115-016-0136-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The clinical picture of catatonia includes impressive motor phenomena, such as rigidity, dyskinesia, festination, negativism, posturing, catalepsy, stereotypies and mannerisms, along with affective (e. g. aggression, anxiety, anhedonism or emotional lability) and behavioral symptoms (e.g. mutism, autism, excitement, echolalia or echopraxia). In English speaking countries seven catatonia rating scales have been introduced, which are widely used in clinical and scientific practice. In contrast, only one validated catatonia rating scale is available in Germany so far. In this paper, we introduce the German version of the Northoff catatonia rating scale (NCRS-dv). The original English version of the NCRS consists of 40 items describing motor (13 items), affective (12 items) and behavioral (15 items) catatonic symptoms. The NCRS shows high internal reliability (Crombachs alpha = 0.87), high interrater (r = 0.80-0.96) and high intrarater (r = 0.80-0.95) reliability. Factor analysis of the NCRS revealed four domains: affective, hyperactive or excited, hypoactive or retarded and behavior with individual eigenvalues of 8.98, 3.61, 2.98 and 2.82, respectively, which explained 21.5 %, 9.3 %, 7.6 % and 7.2 % of variance, respectively. In conclusion, the NCRS-dv represents a second validated instrument which can be used by German clinicians and scientists for the assessment of catatonic symptoms.
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Abstract
LEARNING OBJECTIVES After participating in this activity, learners should be better able to:• Assess the etiologies associated with catatonia in children and adolescents• Evaluate the differential diagnosis of pediatric catatonia• Interpret the literature regarding the treatment of children and adolescents with catatonia OBJECTIVE: Pediatric catatonia is associated with many medical and psychiatric conditions. Mortality is high, and proper treatment can be lifesaving. Catatonia is increasingly recognized in pediatric populations, in which about 20% of cases are related to underlying medical conditions. To minimize morbidity, clinicians must rule out underlying disorders while simultaneously managing symptoms and causes. In our review we discuss (1) recommendations to aid rapid decision making, both diagnostic and therapeutic, (2) emergent conditions and management, (3) disorders associated with pediatric catatonia, including developmental, acquired, idiopathic, and iatrogenic etiologies, (4) available treatments, and (5) medicolegal considerations. METHODS Initial PubMed search without date constraints using MeSH terms related to pediatric catatonia, with subsequent searches on pertinent subtopics using PubMed and Google Scholar. RESULTS Pediatric catatonia is a dangerous but treatable neuropsychiatric condition. Psychiatrists need to be aware of differential diagnoses and to be able determine appropriate treatment within a short time frame. With prompt diagnosis and treatment, outcomes can be optimized. CONCLUSION Pediatric catatonia is underdiagnosed and requires rapid evaluation and management.
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16
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Lin CC, Hung YY, Tsai MC, Huang TL. Increased serum anti-N-methyl-D-aspartate receptor antibody immunofluorescence in psychiatric patients with past catatonia. PLoS One 2017; 12:e0187156. [PMID: 29073246 PMCID: PMC5658162 DOI: 10.1371/journal.pone.0187156] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Accepted: 10/14/2017] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVE Anti-N-methyl-D-aspartate receptor (NMDAR) antibody was thought to be the cause of anti-NMDAR encephalitis, with manifestations similar to catatonia and schizophrenia. Anti-NMDAR antibody in neuropsychiatric patients who had catatonia before were investigated in a follow-up evaluation. The intensity of antibody immunofluorescence was quantified and compared with healthy controls. METHOD Nineteen patients (eight males and eleven females) agreed to be followed-up. Thirteen had the diagnosis of schizophrenia, two had the diagnosis of major depressive disorder, two had bipolar disorder, one had postpartum depression, and one had herpes simplex encephalitis. No patient had catatonia during the follow-up. Nineteen sex-matched healthy controls were recruited. RESULTS Using Mann-Whitney U test, patients had greater intensity of anti-NMDAR antibody immunofluorescence than the healthy controls (121,979 ± 86,526 vs. 47,692 ± 26,102, p = 0.003). No correlation was found between immunofluorescence intensity and catatonia scales or symptom severity scores. Neuropsychiatric patients with past catatonia showed greater anti-NMDAR antibody response than the healthy controls. CONCLUSION NMDAR dysfunction might play a role in the mechanism underlying catatonia. Further studies are needed to confirm this finding.
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Affiliation(s)
- Chin-Chuen Lin
- Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Yi-Yung Hung
- Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Meng-Chang Tsai
- Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Tiao-Lai Huang
- Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
- * E-mail:
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17
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Malas N, Brahmbhatt K, McDermott C, Smith A, Ortiz-Aguayo R, Turkel S. Pediatric Delirium: Evaluation, Management, and Special Considerations. Curr Psychiatry Rep 2017; 19:65. [PMID: 28801871 DOI: 10.1007/s11920-017-0817-3] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Delirium describes a syndrome of acute brain dysfunction with severe consequences on patient outcomes, medical cost, morbidity, and mortality. It represents a final common pathway of numerous pathophysiologic disturbances disrupting cerebral homeostasis. The diagnosis is predicated on recognition of the clinical features of the syndrome through ongoing clinical assessment. Early identification can be aided by routine screening, particularly in high-risk populations. Evaluation and management are continuous and simultaneous processes involving a multidisciplinary care team including child psychiatry consultation. Prevention, early identification and management are critical in alleviating symptoms, improving outcomes, and reducing distress for patients, families, and care teams. This review highlights our current understanding regarding pediatric delirium, its mechanisms, clinical manifestations, detection and management.
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Affiliation(s)
- Nasuh Malas
- Department of Psychiatry and Pediatrics, University of Michigan Medical School, 1500 East Medical Center Drive, L5023, SPC 5277, Ann Arbor, MI, 48109, USA.
| | - Khyati Brahmbhatt
- Department of Psychiatry, University of California San Francisco Benioff Children's Hospital, San Francisco, CA, USA
| | - Cristin McDermott
- Department of Psychiatry and Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, USA
| | - Allanceson Smith
- Department of Psychiatry, University of California San Francisco Benioff Children's Hospital, San Francisco, CA, USA
| | - Roberto Ortiz-Aguayo
- Department of Psychiatry and Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, USA
| | - Susan Turkel
- Department of Psychiatry and Pediatrics, Keck School of Medicine, University of Southern California, Children's Hospital of Los Angeles, CA, Los Angeles, USA
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Ferrafiat V, Raffin M, Deiva K, Salle-Collemiche X, Lepine A, Spodenkiewicz M, Michelet I, Haroche J, Amoura Z, Gerardin P, Cohen D, Consoli A. Catatonia and Autoimmune Conditions in Children and Adolescents: Should We Consider a Therapeutic Challenge? J Child Adolesc Psychopharmacol 2017; 27:167-176. [PMID: 27093093 DOI: 10.1089/cap.2015.0086] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Catatonia as a result of autoimmune conditions offers new therapeutic opportunities for patients that child and adolescent psychiatrists should consider. However, the diagnosis is sometimes challenging when an autoimmune signature is not identified. METHODS In this study, we aim to summarize seven cases from a 20-year series of 84 youths with catatonia, including three cases that represented a diagnostic challenge because of the absence of positive autoimmune testing. RESULTS Immunosuppressive/modulatory treatment improved catatonic and psychotic features in all cases. CONCLUSION To facilitate treatment decision-making, we propose a causality assessment score and a treatment algorithm, which may help clinicians consider whether an autoimmune condition is associated with catatonia.
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Affiliation(s)
- Vladimir Ferrafiat
- 1 Department of Child and Adolescent Psychiatry, Université Pierre et Marie Curie , Hôpital Pitié-Salpêtrière, AP-HP, Paris, France .,2 Department of Child and Adolescent Psychiatry, Université de Rouen , Hôpital Charles Nicolle, AP-HR, Rouen, France
| | - Marie Raffin
- 1 Department of Child and Adolescent Psychiatry, Université Pierre et Marie Curie , Hôpital Pitié-Salpêtrière, AP-HP, Paris, France
| | - Kumaran Deiva
- 3 Department of Neuropediatrics, Université Paris XI , Hôpital Bicêtre, AP-HP, Paris, France
| | - Xavier Salle-Collemiche
- 4 Departments of Child and Adolescent Psychiatry, Université de la Méditerranée , Hôpital St Marguerite, AP-HM, Marseille, France
| | - Anne Lepine
- 5 Department of Neuropediatrics, Université de la Méditerranée , Hôpital La Timone, AP-HM, Marseille, France
| | - Michel Spodenkiewicz
- 1 Department of Child and Adolescent Psychiatry, Université Pierre et Marie Curie , Hôpital Pitié-Salpêtrière, AP-HP, Paris, France
| | - Isabelle Michelet
- 6 Department of Pediatrics, Centre Hospitalier Universitaire (CHU) de Rouen , Rouen, France
| | - Julien Haroche
- 7 Department of Internal Medicine, E3M Institute, Université Pierre et Marie Curie , Hôpital Pitié-Salpêtrière, AP-HR, Paris, France
| | - Zahir Amoura
- 7 Department of Internal Medicine, E3M Institute, Université Pierre et Marie Curie , Hôpital Pitié-Salpêtrière, AP-HR, Paris, France
| | - Priscille Gerardin
- 2 Department of Child and Adolescent Psychiatry, Université de Rouen , Hôpital Charles Nicolle, AP-HR, Rouen, France
| | - David Cohen
- 1 Department of Child and Adolescent Psychiatry, Université Pierre et Marie Curie , Hôpital Pitié-Salpêtrière, AP-HP, Paris, France .,8 CNRS UMR 7222, Institut des Systèmes Intelligents et Robotiques, Université Pierre et Marie Curie , Hôpital Pitié-Salpêtrière, AP-HP, Paris, France
| | - Angèle Consoli
- 1 Department of Child and Adolescent Psychiatry, Université Pierre et Marie Curie , Hôpital Pitié-Salpêtrière, AP-HP, Paris, France .,9 Groupe de Recherche Clinique, Abord dimensionnel des épisodes psychotiques de l'enfant et de l'adolescent: implications génétiques, métaboliques et auto-immunes, Université Pierre et Marie Curie , Hôpital Pitié-Salpêtrière, AP-HP, Paris, France
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19
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Remy KE, Custer JW, Cappell J, Foster CB, Garber NA, Walker LK, Simon L, Bagdure D. Pediatric Anti- N-Methyl-d-Aspartate Receptor Encephalitis: A Review with Pooled Analysis and Critical Care Emphasis. Front Pediatr 2017; 5:250. [PMID: 29226117 PMCID: PMC5705558 DOI: 10.3389/fped.2017.00250] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Accepted: 11/06/2017] [Indexed: 12/12/2022] Open
Abstract
PURPOSE Anti-N-methyl-d-aspartate receptor (NMDAR) encephalitis is being recognized with increasing frequency among children. Given the paucity of evidence to guide the critical care management of these complex patients, we provide a comprehensive review of the literature with pooled analysis of published case reports and case series. METHODS We performed a comprehensive literature search using PubMed, Scopus, EMBASE, and Web of Science for relevant published studies. The literature search was conducted using the terms NMDA, anti-NMDA, Anti-N-methyl-d-aspartate, pediatric encephalitis, and anti-NMDAR and included articles published between 2005 and May 1, 2016. RESULTS Forty-eight references met inclusion criteria accounting for 373 cases. For first-line treatments, 335 (89.8%) received high-dose corticosteroids, 296 received intravenous immunoglobulin (79.3%), and 116 (31%) received therapeutic plasma exchange. In these, 187 children (50.1%) had a full recovery with only minor deficits, 174 patients (46.7%) had partial recovery with major deficits, and 12 children died. In addition, 14 patients were reported to require mechanical ventilation. CONCLUSION Anti-NMDA encephalitis is a formidable disease with great variation in clinical presentation and response to treatment. With early recognition of this second most common cause of pediatric encephalitis, a multidisciplinary approach by physicians may provide earlier access to first- and second-line therapies. Future studies are needed to examine the efficacy of these current therapeutic strategies on long-term morbidity.
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Affiliation(s)
- Kenneth E Remy
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Maryland School of Medicine, Baltimore, MD, United States.,Critical Care Medicine Department, Clinical Center, The National Institutes of Health, Bethesda, MD, United States.,Division of Pediatric Critical Care, Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, United States
| | - Jason W Custer
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Maryland School of Medicine, Baltimore, MD, United States
| | - Joshua Cappell
- Divisions of Pediatric Neurology and Critical Care, Departments of Neurology and Pediatrics, Morgan Stanley Children's Hospital, Columbia University College of Physicians and Surgeons, New York, NY, United States
| | - Cortney B Foster
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Maryland School of Medicine, Baltimore, MD, United States
| | - Nan A Garber
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Maryland School of Medicine, Baltimore, MD, United States
| | - L Kyle Walker
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Maryland School of Medicine, Baltimore, MD, United States
| | - Liliana Simon
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Maryland School of Medicine, Baltimore, MD, United States
| | - Dayanand Bagdure
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Maryland School of Medicine, Baltimore, MD, United States
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20
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Electroconvulsive Therapy in Anti-N-Methyl-D-Aspartate Receptor Encephalitis: A Case Report and Review of the Literature. J ECT 2016; 32:225-229. [PMID: 27295461 DOI: 10.1097/yct.0000000000000334] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES There is a growing scientific literature describing the neuropsychiatric symptoms of anti-N-methyl-D-aspartate (NMDA) receptor encephalitis, including the use of electroconvulsive therapy (ECT) to treat those symptoms. We sought to consolidate this literature into a review that highlights its relevance to ECT practitioners. METHODS We performed a PubMed search using the terms electroconvulsive therapy and encephalitis, autoimmune encephalitis, or anti-NMDA receptor encephalitis. We reviewed all relevant studies in detail, cross-referenced all bibliographies, and collected key clinical information related to the practice of ECT. RESULTS We identified 6 studies offering patient-level descriptions of the use of ECT in patients with anti-NMDA receptor encephalitis. In all cases ECT was used to target symptoms of catatonia. Electroconvulsive therapy was delivered safely and effectively irrespective of the timing of diagnosis, tumor removal, or immunotherapy. CONCLUSIONS There are no controlled data on the use of ECT in anti-NMDA receptor encephalitis. Further investigation is needed to determine whether ECT has a disease-modifying effect on this form of autoimmune encephalitis.
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21
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Successful Treatment of Refractory Dyskinesia Secondary to Anti-N-Methyl-D-Aspartate Receptor Encephalitis With Electroconvulsive Therapy. J ECT 2016; 32:e13-4. [PMID: 26959858 DOI: 10.1097/yct.0000000000000313] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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22
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Dhossche D. Pediatric catatonia: review & new vagal theory. FUTURE NEUROLOGY 2015. [DOI: 10.2217/fnl.15.31] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Recent studies support that catatonia may be more common in children and adolescents than previously thought. A boost for the recognition of pediatric catatonia comes from changes in DSM-5 accommodating the diagnosis of catatonia in a wider range of disorders, including developmental and autistic spectrum disorders in addition to schizophrenic, affective, and medical disorders including autoimmune conditions such as lupus or anti-N-methyl-D-aspartic acid receptor encephalitis. The current status of pediatric catatonia, its assessment and treatment are described. Theories modeling the mechanism of catatonia are reviewed, including a vagal theory implicating the immobilization reflex mediated by the vagal nerve.
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Affiliation(s)
- Dirk Dhossche
- Department of Psychiatry, University of Mississippi Medical Center, 2500 North State Street, Jackson, MS 39216, USA
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23
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Varma A, Sapra M. Anti-NMDA Receptor Encephalitis: A Need for Increased Awareness Among Psychiatrists. Psychiatr Ann 2015. [DOI: 10.3928/00485713-20151103-08] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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24
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Lin CC, Huang TL. Benzodiazepine treatment of catatonia. FUTURE NEUROLOGY 2015. [DOI: 10.2217/fnl.15.33] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
The mechanisms of catatonia may involve the GABA system, dopamine system, glutamate/N-methyl-D-aspartate receptor system and brain-derived neurotrophic factor. In this article we will share our experiences in treating catatonia with benzodiazepines in Taiwan. We will look at catatonia and its association with anti-N-methyl-D-aspartate receptor encephalitis, and lastly, reports on predicting outcome of patients with catatonia will also be discussed.
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Affiliation(s)
- Chin-Chuen Lin
- Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital & Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Tiao-Lai Huang
- Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital & Chang Gung University College of Medicine, Kaohsiung, Taiwan
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25
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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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26
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Kusztal M, Piotrowski P, Mazanowska O, Misiak B, Kantorska-Janiec M, Boratyńska M, Klinger M, Kiejna A. Catatonic episode after kidney transplantation. Gen Hosp Psychiatry 2014; 36:360.e3-5. [PMID: 24559791 DOI: 10.1016/j.genhosppsych.2014.01.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2013] [Revised: 12/30/2013] [Accepted: 01/07/2014] [Indexed: 11/16/2022]
Abstract
There is a growing body of case reports of catatonic symptoms after organ transplantations. A considerable number of these cases might be attributed to neurotoxicity induced by immunosuppressive medications. However, the etiology of other cases remains unclear. We present the case of a 21-year-old woman who developed catatonia after kidney transplantation from a deceased donor. In this case, nontoxic tacrolimus levels were found, and other causal factors including infections, uremia or transplant rejection were excluded. Electroconvulsive therapy followed by olanzapine proved to be effective treatment.
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Affiliation(s)
- Mariusz Kusztal
- Department of Nephrology and Transplantation Medicine, Wroclaw Medical University, Poland.
| | | | - Oktawia Mazanowska
- Department of Nephrology and Transplantation Medicine, Wroclaw Medical University, Poland
| | - Błażej Misiak
- Department of Psychiatry, Wroclaw Medical University, Poland; Department of Genetics, Wroclaw Medical University, Poland
| | | | - Maria Boratyńska
- Department of Nephrology and Transplantation Medicine, Wroclaw Medical University, Poland
| | - Marian Klinger
- Department of Nephrology and Transplantation Medicine, Wroclaw Medical University, Poland
| | - Andrzej Kiejna
- Department of Psychiatry, Wroclaw Medical University, Poland
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