Electroconvulsive therapy for catatonia in anti-NMDA receptor encephalitis: A case series

Abstract

Background: Anti-NMDAR encephalitis is the most common cause of immune-mediated catatonia.

Case series: Three females presented with neuropsychiatric symptoms and were empirically treated with first-line immunotherapy and ovarian teratoma resection for suspected autoimmune encephalitis, preceding diagnostic confirmation via NMDAR antibody positivity. They required escalating large doses of benzodiazepines for refractory malignant catatonia resulting in ICU level care. ECT treatments were initiated, and patients were gradually noted to have clinical improvement as was measured by the Bush-Francis Catatonia Rating Scale.

Conclusions: Clinicians should recognize catatonia among patients with suspected anti-NMDAR encephalitis and consider the early implementation of ECT into treatment algorithms.

Keywords: Anti-N-methyl-d-aspartate receptor encephalitis; Autoimmune encephalitis; Catatonia/therapy; Electroconvulsive therapy.