Successful treatment of emotional disturbances following non-herpetic limbic encephalitis by serotonergic agents. A case report

• Published in: Rinshō shinkeigaku Vol. 41; no. 11; p. 805
• Main Authors: Narikawa, K, Hasegawa, T, Takeda, A, Shiga, Y, Itoyama, Y
• Format: Journal Article
• Language: Japanese
• Published: Japan 01.11.2001
• Subjects: Adult; Affective Symptoms - drug therapy; Affective Symptoms - etiology; Female; Humans; Isoindoles; Limbic Encephalitis - complications; Piperazines - therapeutic use; Pyrimidines - therapeutic use; Serotonin Receptor Agonists - therapeutic use
• ISSN: 0009-918X

We report a 19-year-old woman who developed refractory status epilepticus due to non-herpetic limbic encephalitis. Because ordinary anti-epileptics were ineffective, general anesthesia under mechanical ventilation was begun with pentobarbital, midazolam, and propofol. After 4 months, we could finally discontinue the intravenous anesthetics. Then, she gradually became conscious and several weeks later, could communicate verbally. Simultaneously, she began to manifest psychomotor agitation and emotional incontinence mimicking Klüver-Bucy syndrome. Brain MRI revealed cortical atrophy in the fronto-temporal lobes and dilated anterior and inferior horns of the lateral ventricles. Dopamine blockers and benzodiazepines failed to resolve these emotional symptoms. Oral tandospirone (30 mg/day dose) was initiated and a partial regression was observed. The following administration of fluvoxamine (started with 12.5 mg/day and maintained with 75 mg/day) resulted in a dramatic improvement of her symptoms within 3 days. This clinical course suggests that impaired serotonergic neurotransmission plays a key role in her emotional disturbances and that its modulation by serotonergic agents is useful to relieve such symptoms.