Disclosures: Carly J. Rothman, DO: Nothing to disclose

Case Description: A previously independent and healthy 22-year-old female presented with a 3-day history of bizarre behavior. Her exam was significant for tachycardia, echolalia, waxy flexibility, anorexia and psychosis. Ultrasound revealed a right ovarian dermoid cyst, and CSF was positive for NMDA receptor antibodies, confirming the diagnosis of anti-NMDA receptor (NMDAR) encephalitis. She required intensive care unit monitoring for autonomic instability and seizure-like activity, and underwent oophorectomy and combination immunotherapy with some improvement. Upon admission to rehab she required maximum assistance for dressing and grooming, with fluctuating neuro-arousal. She was transferred back to the acute hospital due to worsening catatonic symptoms, violent episodes, and autonomic instability.

Setting: Tertiary Referral Hospital

Patient: A 22-year-old female with functional recovery after treatment with electroconvulsive therapy (ECT) for refractory catatonia due to anti-NMDAR encephalitis.

Assessment/Results: ECT was combined with high dose benzodiazepine therapy, with improvement measured by the Bush Francis Catatonia Rating Scale (BFCRS). Results were seen after the first treatment, and after 12 sessions she was discharged to outpatient brain injury rehabilitation at a supervision level.

Discussion: Anti-NMDAR encephalitis is a life-threatening disease with high risk for immobility related complications, often requiring prolonged rehabilitation. Catatonia due to anti-NMDAR encephalitis can be a barrier to achieving functional goals, as patients are not able to effectively participate in therapy. ECT is a promising and safe treatment to improve functional recovery in these patients. The BFCRS should be used by consultant and inpatient physiatrists to screen and monitor progression of catatonia.

Conclusion: This young woman had partial symptom relief following medical therapy for NMDAR-encephalitis with catatonia but was unable to participate in acute inpatient rehab. ECT was initiated almost 4 months after initial presentation with remarkable recovery allowing for discharge to the community, demonstrating the potential benefit of ECT in achieving functional outcomes in NMDAR-encephalitis.

Level of Evidence: Level V

« Back to AAPM&R Annual Assembly 2019

PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/functional-recovery-after-treatment-with-electroconvulsive-therapy-for-refractory-catatonia-due-to-anti-nmda-receptor-encephalitis/