Complete cognitive recovery in a severe case of anti-N-methyl-d-aspartate receptor encephalitis treated with electroconvulsive therapy

• Published in: BMJ case reports Vol. 13; no. 2; p. e233772
• Main Authors: Leding, Cæcilie, Marstrand, Lisbet, Jorgensen, Anders
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group LTD 06.02.2020; BMJ Publishing Group
• Series: Case report
• Subjects: Adult; Anti-N-Methyl-D-Aspartate Receptor Encephalitis - diagnosis; Anti-N-Methyl-D-Aspartate Receptor Encephalitis - therapy; Case reports; Cerebrospinal Fluid - chemistry; Cognition; Cognitive Dysfunction - complications; Delirium; Electroconvulsive Therapy; Encephalitis; Female; Humans; Memory; Neuropsychological Tests; Patients; Psychosis; Recovery (Medical); Unexpected Outcome (Positive or Negative) Including Adverse Drug Reactions; psychiatry; memory disorders; delirium; neurology
• ISSN: 1757-790X; 1757-790X
• DOI: 10.1136/bcr-2019-233772

Anti-N-methyl-d-aspartate (NMDA) receptor encephalitis usually presents with prominent neuropsychiatric symptoms and many patients experience cognitive sequelae. Electroconvulsive therapy (ECT) has been suggested as a part of the treatment, particularly for catatonia, but concerns that ECT may worsen the cognitive function and long-term outcome may limit its use. We present a case of anti-NMDA receptor encephalitis with severe neuropsychiatric manifestations including refractory catatonia and behavioural change. A pre-ECT neuropsychological assessment revealed dysfunction in multiple cognitive domains in spite of intensive pharmacological treatment. Twenty days after the ninth and last ECT treatment, the patient underwent the same neuropsychological tests, which showed normalised test results within all cognitive domains and no need of rehabilitation. The case demonstrates that the use of ECT in anti-NMDA receptor encephalitis with severe pretreatment cognitive dysfunction can be associated with a highly favourable cognitive outcome.