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Gama Marques J. Never Forget About Catatonia Secondary to Organic Conditions. J ECT 2024:00124509-990000000-00188. [PMID: 39012124 DOI: 10.1097/yct.0000000000001015] [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: 07/17/2024]
Affiliation(s)
- João Gama Marques
- Consulta de Esquizofrenia Resistente, Hospital Júlio de Matos, Unidade Local de Saúde de São José, Centro Clínico Académico de Lisboa; Clínica Universitária de Psiquiatria e Psicologia Médica, Faculdade de Medicina, Universidade de Lisboa, Centro Académico de Medicina de Lisboa, Lisboa, Portugal
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Giri YR, Parrill A, Damodar S, Fogel J, Ayed N, Syed M, Korie I, Ayyanar S, Typhair C, Hashmi S, Giri BB. Anti-N-methyl-D-aspartate receptor encephalitis in adults: a systematic review and analysis. NEUROPSYCHIATRIE : KLINIK, DIAGNOSTIK, THERAPIE UND REHABILITATION : ORGAN DER GESELLSCHAFT OSTERREICHISCHER NERVENARZTE UND PSYCHIATER 2024; 38:92-101. [PMID: 37548868 DOI: 10.1007/s40211-023-00478-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 07/01/2023] [Indexed: 08/08/2023]
Abstract
PURPOSE To analyze predictors of treatment outcome for anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis in adults. METHODS We performed a comprehensive literature search of PubMed, PsycInfo, and OVID. We included 424 patients from case reports and case series. Demographics, anti-NMDAR antibodies, prodromal and presenting symptoms, diagnostic workup, and treatment variables were recorded. Inferential analyses were performed in the subset (n = 299) of those with known treatment outcomes. Multivariate multinomial logistic regression analysis for treatment outcome compared full recovery versus partial recovery and full recovery versus death. RESULTS Treatment outcomes consisted of 34.67% full recovery (n = 147), 30.90% partial recovery (n = 131), 4.95% death (n = 21), and 29.48% unknown (n = 125). Speech/language abnormality and abnormal electroencephalogram (EEG) were each significantly associated with a higher relative risk for a full recovery. Treatment with intravenous immunoglobulin and plasmapheresis were each significantly associated with a higher relative risk for partial recovery. The analysis comparing death to full recovery found that catatonia was significantly associated with a lower relative risk for death. Increased age, orofacial dyskinesia, and no tumor removal were each significantly associated with a higher relative risk for death. CONCLUSION Increased age, orofacial dyskinesia, and no tumor removal were associated with a higher relative risk for death in anti-NMDAR encephalitis in adults. Clinicians should monitor and appropriately treat anti-NMDAR encephalitis with these findings to minimize the risk of death.
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Affiliation(s)
- Yam R Giri
- Department of Psychiatry and Behavioral Sciences, Nassau University Medical Center, Hempstead Turnpike, 2201, East Meadow, NY, USA.
| | - Allison Parrill
- Lake Erie College of Osteopathic Medicine, 1858 W Grandview Blvd, Erie, PA, USA
| | - Sreedevi Damodar
- College of Medicine, Department of Psychiatry, University of Central Florida, Gainesville, FL, USA
| | - Joshua Fogel
- Department of Business Management, Brooklyn College, Brooklyn, NY, USA
| | - Nisrin Ayed
- Ascension Maccomb-Oakland Hospital, Warren, MI, USA
| | | | | | - Sivaranjani Ayyanar
- Department of Psychiatry and Behavioral Sciences, Nassau University Medical Center, Hempstead Turnpike, 2201, East Meadow, NY, USA
| | | | - Seema Hashmi
- Department of Psychiatry and Behavioral Sciences, Nassau University Medical Center, Hempstead Turnpike, 2201, East Meadow, NY, USA
| | - Bom B Giri
- Xuzhou Medical University, Xuzhou, Jiangsu, China
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Wu H, Wu C, Zhou Y, Huang S, Zhu S. Catatonia in adult anti-NMDAR encephalitis: an observational cohort study. BMC Psychiatry 2023; 23:94. [PMID: 36750806 PMCID: PMC9903498 DOI: 10.1186/s12888-022-04505-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Accepted: 12/28/2022] [Indexed: 02/09/2023] Open
Abstract
BACKGROUND Anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis is one of the most prevalent autoimmune encephalitis and is closely related to catatonia. This study aimed to investigate the clinical features and disease outcomes of adult catatonic anti-NMDAR encephalitis patients. METHODS Adult patients diagnosed with anti-NMDAR encephalitis between January 2013 and October 2021 were retrospectively enrolled in this study. According to the Bush Francis Catatonia screening instrument (BFCSI), patients were divided into two groups: those with catatonia and those without catatonia. The modified Rankin scale (mRS), Clinical Assessment Scale for Autoimmune Encephalitis (CASE), Neuropsychiatric Inventory (NPI), Patient Health Questionnaire-9 (PHQ-9) and 7-item Generalized Anxiety Disorder Questionnaire (GAD-7) scores were assessed at follow-up. The Mann-Whitney U test (nonparametric), Student's t test (parametric), and chi-squared test were used to analyse the differences between the two groups. RESULTS Eighty-four patients were recruited, including twenty-five catatonic patients and fifty-nine noncatatonic patients. Among them, 28 had positive antibody only in cerebrospinal fluid (CSF), 4 had positive antibody only in serum and 52 had positive antibody both in CSF and serum. Catatonic patients experienced more disturbance of consciousness (p = 0.01), aggression (p = 0.046) and affective disorders (p = 0.043) than noncatatonic patients. The mRS scores of the catatonia group assessed at admission (p = 0.045) were worse than those of the non-catatonia group. Catatonic patients were more inclined to develop deep vein thrombosis (p = 0.003), decubitus (p = 0.046), pneumonia (p = 0.025), and to be admitted to the intensive care unit (ICU) (p = 0.011) than noncatatonic patients. All patients in the catatonia group received first-line immunotherapy. At the 24-month follow-up, 2 patients in the catatonia group did not achieve good outcomes. At the last follow-up, the catatonia group had more relapses (p = 0.014) and more neuropsychiatric problems (p = 0.035). CONCLUSIONS Adult anti-NMDAR encephalitis patients with catatonia present distinct clinical features in disease course and are prone to experience more relapses and long-term neuropsychiatric problems than those without catatonia.
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Affiliation(s)
- Huiting Wu
- grid.33199.310000 0004 0368 7223Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Wuhan, 430030 Hubei China
| | - Chunmei Wu
- grid.33199.310000 0004 0368 7223Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Wuhan, 430030 Hubei China
| | - Yingying Zhou
- grid.33199.310000 0004 0368 7223Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Wuhan, 430030 Hubei China
| | - Shanshan Huang
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Wuhan, 430030, Hubei, China.
| | - Suiqiang Zhu
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Wuhan, 430030, Hubei, China.
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Silva Gadelho L, Gama Marques J. Catatonia associated with epileptic seizures: A systematic review of case reports. Epilepsy Res 2022; 186:107016. [PMID: 36116265 DOI: 10.1016/j.eplepsyres.2022.107016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 08/13/2022] [Accepted: 08/30/2022] [Indexed: 11/03/2022]
Abstract
The association of catatonia with epileptic seizures is a rare phenomenon that is poorly understood and needs more clinical research. This systematic review included all published case reports of patients with catatonia meeting ICD-11 criteria associated with epileptic seizures, published until December 2021 in PubMed. Case reports were synthesized and results were expressed as percentages. In total, 42 articles with 52 case reports were included. Most patients were adults with a dispersed age (mean age 44.9 ± 19.3), slightly more males (59.6 %), with psychiatric history (76.9 %) of affective disorders (26.9 %) or psychotic episodes (13.5 %) and/or neurological history (61.5 %) of epileptic seizures (38.5 %) or head trauma (13.5 %). Their clinical presentation consisted mostly of decreased psychomotor activity (mutism: 94.2 %; stupor: 78.8 %; staring: 57.7 %; negativism: 36.5 %) with some abnormal psychomotor activity (catalepsy: 40.4 %; rigidity: 40.4 %; waxy flexibility: 23.1 %; posturing: 21.2 %) and half had clinical epileptic seizures (51.9 %), mostly generalized tonic-clonic (23.1 %). Almost all electroencephalograms (97.9 %) and half of brain imaging exams (47.4 %) performed had abnormal findings. The epileptic activity was mainly generalized (50 %) and associated with primary epilepsy (30.8 %), iatrogenesis (23.1 %), other secondary aetiologies (25 %) or unknown causes (21.2 %). Most improved with antiepileptic therapy (87.5 %) and had a complete remission (86.5 %). Catatonia secondary to epileptic seizures often has a nonspecific clinical presentation and appears in patients with previous psychiatric diagnoses, so any patient with catatonia should be properly investigated to avoid misdiagnosis and ineffective treatments.
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Affiliation(s)
- Luís Silva Gadelho
- Clínica Universitária de Psiquiatria e Psicologia Médica, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
| | - João Gama Marques
- Clínica Universitária de Psiquiatria e Psicologia Médica, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal; Consulta de Esquizofrenia Resistente, Centro Hospitalar Psiquiátrico de Lisboa, Lisboa, Portugal.
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Pacheco‐Barrios K, Navarro‐Flores A, de Melo PS, Rebello‐Sanchez I, Parente J, Asenjo ED, Gordillo I, Zeña‐Ñañez S, Failoc‐Rojas VE. Neuroleptic intolerance in the context of anti‐N‐methyl‐D‐aspartate receptor encephalitis: A systematic review and synthesis of global case reports. Acta Neurol Scand 2022; 146:410-428. [DOI: 10.1111/ane.13693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 08/11/2022] [Accepted: 08/14/2022] [Indexed: 11/28/2022]
Affiliation(s)
- Kevin Pacheco‐Barrios
- Unidad de Investigación para la Generación y Síntesis de Evidencias en Salud Universidad San Ignacio de Loyola Lima Peru
- Neuromodulation Center and Center for Clinical Research Learning Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Harvard Medical School Boston Massachusetts USA
| | - Alba Navarro‐Flores
- International Max Planck Research School for Neurosciences Georg‐August‐University Göttingen Göttingen Germany
| | - Paulo S. de Melo
- Neuromodulation Center and Center for Clinical Research Learning Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Harvard Medical School Boston Massachusetts USA
| | - Ingrid Rebello‐Sanchez
- Neuromodulation Center and Center for Clinical Research Learning Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Harvard Medical School Boston Massachusetts USA
| | - Joao Parente
- Neuromodulation Center and Center for Clinical Research Learning Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Harvard Medical School Boston Massachusetts USA
| | - Elenit Diaz Asenjo
- Servicio de Medicina Interna Hospital Regional Lambayeque Lambayeque Peru
| | - Ivan Gordillo
- Servicio de Medicina Interna Hospital Regional Lambayeque Lambayeque Peru
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Sun Z, Li Q, Li X, Shi Y, Nan C, Jin Q, Wang X, Zhuo Y, Zhao Z. Casein kinase 2 attenuates brain injury induced by intracerebral hemorrhage via regulation of NR2B phosphorylation. Front Cell Neurosci 2022; 16:911973. [PMID: 35928572 PMCID: PMC9345180 DOI: 10.3389/fncel.2022.911973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Accepted: 06/27/2022] [Indexed: 11/16/2022] Open
Abstract
Objective Intracerebral hemorrhage (ICH) is a common cerebrovascular disease with high incidence, disability, and mortality. Casein kinase 2 (CK2) is a serine/threonine kinase with hundreds of identified substrates and plays an important role in many diseases. This study aimed to explore whether CK2 plays protective roles in ICH-induced neuronal apoptosis, inflammation, and oxidative stress through regulation NR2B phosphorylation. Methods CK2 expression level of brain tissues taken from ICH patients was determined by immunoblotting. Neurons from embryonic rat and astrocytes from newborn rats were cultured and treated by Hemoglobin chloride (Hemin). The proliferation of astrocytes, the apoptosis and oxidative stress of neurons and the inflammatory factors of astrocytes were detected. CK2 expression was determined in ICH model rats. The effects of CK2 overexpression plasmid (pc-CK2) on neurobehavioral defects and brain water content in ICH rats were observed. Results CK2 expression in ICH patients was down-regulated. Overexpression of CK2 promoted the astrocyte proliferation, inhibited neuronal apoptosis, and reduced astrocyte-mediated inflammation. N-methyl-D-aspartate receptor 2B (NR2B) reversed the effects of pc-CK2 on neurons and astrocytes. CK2 phosphorylated NR2B at the S1480 site, down-regulated the expression of NR2B and interfered with the interaction between NR2B and postsynaptic density protein 95 (PSD95). In vivo experiments showed that the expression of CK2 decreased and the expression of NR2B increased in ICH rats. Furthermore, pc-CK2 attenuated neurobehavioral defects, brain water content and neuronal damage in ICH rats. Conclusion CK2 phosphorylated NR2B, down-regulated the expression of NR2B, interfered with the interaction between NR2B and PSD95, alleviated inflammatory reactions, inhibited neuronal apoptosis and oxidative stress after ICH. CK2 and NR2B may be new potential therapeutic targets for the treatment of ICH. However, the limitation of this study is that we only investigated the regulation of NR2B by CK2.
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Affiliation(s)
- Zhimin Sun
- Department of Neurosurgery, The Second Hospital of Hebei Medical University, Shijiazhuang, China
- Department of Neurosurgery, The Third Hospital of Shijiazhuang City, Shijiazhuang, China
| | - Qiyao Li
- Department of Neurosurgery, The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Xiaopeng Li
- Department of Neurosurgery, The Second Hospital of Hebei Medical University, Shijiazhuang, China
- Department of Neurosurgery, The First Hospital of Handan City, Handan, China
| | - Yunpeng Shi
- Department of Neurosurgery, The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Chengrui Nan
- Department of Neurosurgery, The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Qianxu Jin
- Department of Neurosurgery, The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Xiaoyan Wang
- Department of Neurosurgery, The Second Hospital of Hebei Medical University, Shijiazhuang, China
- Department of Neurosurgery, Hebei General Hospital, Shijiazhuang, China
| | - Yayu Zhuo
- Department of Neurosurgery, The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Zongmao Zhao
- Department of Neurosurgery, The Second Hospital of Hebei Medical University, Shijiazhuang, China
- *Correspondence: Zongmao Zhao,
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Neerukonda N, Bliss M, Jafroodifar A, Leontieva L. Olanzapine and Lorazepam Used in the Symptomatic Management of Excited Catatonia Secondary to Anti-N-Methyl-D-Aspartate Receptor Encephalitis. Cureus 2020; 12:e8689. [PMID: 32577332 PMCID: PMC7305573 DOI: 10.7759/cureus.8689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Anti-N-methyl-D-aspartate (NMDA) receptor encephalitis has become one of the more well-known autoimmune diseases affecting the brain and it is characterized by a multitude of progressive neuropsychiatric symptoms. The following case describes the clinical course of an 18-year-old female with excited type catatonia secondary to anti-NMDA receptor encephalitis. The patient had been brought to the ED by her parents in an acutely psychotic state characterized by profound disorganization and vivid visual hallucinations. She was admitted to psychiatry and her hospital course was significant for both retarded and excited type catatonia, autonomic instability, and sensitivity to multiple neuroleptics. Given the atypicality of her symptoms and a family history of autoimmune disease, workup for autoimmune encephalitis was performed. MRI of the pelvis showed an indeterminate ovarian mass and laboratory studies were generally unremarkable. The catatonic symptoms resolved over the course of three weeks, eventually responding to a combination of lorazepam and olanzapine. Following discharge, a cerebrospinal fluid (CSF) panel resulted with positive titers for anti-NMDA receptor antibodies. This case illustrates the need to consider autoimmune encephalitis in cases of catatonia. It also presents a case in which symptoms of anti-NMDA receptor encephalitis potentially remitted without immunotherapy or mass resection.
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Affiliation(s)
- Namita Neerukonda
- Psychiatry, State University of New York Upstate Medical University, Syracuse, USA
| | - Michael Bliss
- Psychiatry, State University of New York Upstate Medical University, Syracuse, USA
| | - Abtin Jafroodifar
- Radiology, State University of New York Upstate Medical University, Syracuse, USA
| | - Luba Leontieva
- Psychiatry, State University of New York Upstate Medical University, Syracuse, USA
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