Disclosures: Alethea J. Appavu, DO: No financial relationships or conflicts of interest

Case Description: The patient is an 18-year-old male with NMDAR Encephalitis admitted to acute inpatient rehabilitation. Following an LTACH stay and his initial diagnosis one month ago, he was readmitted for sympathetic storming which was later determined to be psychosis and agitation in the setting of chronic NMDAR encephalitis. Progress in AIR was affected by decreased participation, disinhibition with staff, and episodes of agitation. The patient was on levetiracetam, gabapentin, lacosamide, and valproic acid which were weaned during rehabilitation with initiation of quetiapine for agitation management.

Setting: Acute Rehabilitation Hospital

Patient: 18-year-old male with NMDA Receptor Encephalitis Assessment/

Results: After medication titration, the patient’s personality began to return to baseline. He had fewer episodes of aggression and was discharged from AIR at a modified-independent to independent level for gait and ADLs. On follow-up, the patient reported that all symptoms of agitation resolved after removal of anti-epileptic drugs and eventually Seroquel was discontinued.

Discussion: There is literature that suggests, that chronic NMDAR Encephalitis can result in relapses of psychosis involving disinhibition, personality changes, and impulsivity that can occur months to years after initial symptoms and diagnosis. Normally, psychosis occurs acutely in the clinical course and patients return to baseline and improve with treatment of encephalitis. To our knowledge, there are no reports of managing NMDAR encephalitis in a chronic state in acute inpatient rehabilitation.

Conclusion: As far as we are aware, there are no published guidelines for management of chronic NMDAR encephalitis. Identification and aggressive management of agitation and psychosis in chronic NMDAR Encephalitis will lead to a more effective rehab course, better clinical recovery, and less disability.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/aggressive-agitation-management-affecting-acute-rehabilitation-course-in-nmda-receptor-encephalitis-a-case-report-and-suggestion-for-management/