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Yang P, Li L, Xia S, Zhou B, Zhu Y, Zhou G, Tu E, Huang T, Huang H, Li F. Effect of Clozapine on Anti-N-Methyl-D-Aspartate Receptor Encephalitis With Psychiatric Symptoms: A Series of Three Cases. Front Neurosci 2019; 13:315. [PMID: 31024238 PMCID: PMC6465601 DOI: 10.3389/fnins.2019.00315] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Accepted: 03/19/2019] [Indexed: 01/29/2023] Open
Abstract
The main clinical manifestations of anti-N-methyl-D-aspartate receptor (anti-NMDAR) encephalitis are acute or subacute seizures, cognition impairment, and psychiatric symptoms. Nowadays, the scheme of antipsychotic therapy for this disease has not been established. This study reports three cases of anti-NMDAR encephalitis with psychiatric symptoms. The anti-NMDAR antibodies in cerebrospinal fluid (CSF) and serum were positive. The psychiatric symptoms still existed after intravenous immunoglobulin (IVIG) treatment; thus, clozapine was used for antipsychotic therapy. Case 1 was a 37-year-old man who suffered from bad mood and suicide behaviors for 1 month. Hallucination and delusion still existed after IVIG treatment and hormone therapy, and the symptoms were relieved when given clozapine for 12 months. Case 2 was a 28-year-old man who was admitted to our hospital due to injuring other people and destructive behaviors for 2 days. He showed irritability, bad temper, declined cognition, and severe delusion of persecution after IVIG treatment and hormone therapy, but the psychiatric symptoms disappeared when given clozapine for 3 months. Case 3 was a 23-year-old man who suffered from headache and babbing for 7 days. Symptoms such as irritability, bad temper, babbing, and injuring other people still existed after IVIG treatment and hormone therapy, but they disappeared when given clozapine for 2 months. Therefore, we suggest that during the treatment of anti-NMDAR encephalitis with psychiatric symptoms, if the anti-NMDAR antibodies in CSF and serum were positive, and psychiatric symptoms could not be controlled after IVIG and hormone therapy, clozapine may work.
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Affiliation(s)
- Ping Yang
- Department of Psychiatry, Hunan Brain Hospital, Clinical Medical School, Hunan University of Chinese Medicine, Changsha, China
| | - Liang Li
- Provincial Key Laboratory of TCM Diagnostics, Hunan University of Chinese Medicine, Changsha, China
| | - Shuaishuai Xia
- Provincial Key Laboratory of TCM Diagnostics, Hunan University of Chinese Medicine, Changsha, China
| | - Bin Zhou
- Department of Psychiatry, Hunan Brain Hospital, Clinical Medical School, Hunan University of Chinese Medicine, Changsha, China
| | - Yong Zhu
- Department of Psychiatry, Hunan Brain Hospital, Clinical Medical School, Hunan University of Chinese Medicine, Changsha, China
| | - Gaoya Zhou
- Department of Psychiatry, Hunan Brain Hospital, Clinical Medical School, Hunan University of Chinese Medicine, Changsha, China
| | - Erwen Tu
- Department of Psychiatry, Hunan Brain Hospital, Clinical Medical School, Hunan University of Chinese Medicine, Changsha, China
| | - Tianhao Huang
- Shanghai Institute of Measurement and Testing Technology, Shanghai, China
| | - Huiyong Huang
- Provincial Key Laboratory of TCM Diagnostics, Hunan University of Chinese Medicine, Changsha, China
| | - Feng Li
- Provincial Key Laboratory of TCM Diagnostics, Hunan University of Chinese Medicine, Changsha, China.,School of Dentistry, University of California, Los Angeles, Los Angeles, CA, United States
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