Disclosures: Daniel J. Stagl, DO: Nothing to disclose

Case Description: 30-year-old female with no past medical history presented to acute inpatient rehabilitation with non-traumatic brain injury secondary to anti-NMDA receptor encephalitis caused by ovarian teratoma. MRI brain showed hyperintense signal in the occipital and temporal regions, left greater than right. EEG was consistent with moderate encephalopathy and a lumbar puncture showed anti-NMDA receptors. The patient initially was admitted to acute inpatient rehabilitation with negligible FIM gains. The patient was readmitted to the acute care hospital for persistent catatonia, underwent 10 electroconvulsive therapy sessions with improvement in her catatonia, removal of PEG and tracheostomy tube, and was readmitted to acute inpatient rehabilitation with marked improvements in FIM scores over her stay.

Setting: Acute Inpatient Rehabilitation at Academic Institution

Patient: 30-year-old female

Assessment/Results: The patient initially required total assistance with most activities of daily living except bathing (max assist) and grooming (min assist) and was ambulating with 2 people assistance and a rolling walker for 55 feet during her initial rehabilitation stay. The patient progressed to supervision at all levels for activities of daily living and was ambulating at a mod I level 500 feet with no assistive device after being readmitted to acute inpatient rehabilitation after electroconvulsive therapy.

Discussion: Our patient was initially treated for her encephalitis with corticosteroids, 2 courses of rituximab, 2 courses of cyclophosphamide, IVIg, PLEX, and bortezomib. Her catatonia did not improve after these treatments during her initial stay in acute inpatient rehabilitation and hindered her progression with the therapy teams. After her readmission to acute care with electroconvulsive therapy, she made improved FIM gains in therapy owing to the improvement in her catatonia.

Conclusion: Electroconvulsive therapy may represent a useful resource for refractory catatonia in patients with non-traumatic brain injuries due to encephalitis. These patients may experience improved gains in functional status in acute inpatient rehabilitation once their catatonia has abated.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/anti-nmda-receptor-enchephalitis-with-catatonia-responsive-to-electroconvulsive-therapy-a-case-report/