Jones Kristin C, Schwartz Ann C, Hermida Adriana P, Kahn David A
JONES: Baylor College of Medicine, Houston, TX SCHWARTZ and HERMIDA: Emory University School of Medicine, Atlanta GA KAHN: Columbia University College of Physicians and Surgeons, New York, NY.
J Psychiatr Pract. 2015 Sep;21(5):374-80. doi: 10.1097/PRA.0000000000000100.
We describe the case of a 17-year-old male who presented with acute onset of seizures and malignant catatonia with psychosis, agitation, and hypermetabolism, who responded to electroconvulsive therapy (ECT). Soon after he began to respond, he was diagnosed with anti-N-methyl-D-aspartate (NMDA) receptor encephalitis and then given immunosuppressive therapy. Anti-NMDA receptor encephalitis is an increasingly recognized autoimmune disorder that often presents with neuropsychiatric symptoms. The mainstays for treatment have been early diagnosis, tumor work-up and removal if found, and initiation of immunosuppressive therapy. Treatment response is often slow and residual symptoms common. In this case, ECT produced clinical stabilization before the underlying diagnosis of anti-NMDA receptor encephalitis was made and standard treatment initiated. We suggest that ECT may be highly beneficial for stabilizing life-threatening neuropsychiatric symptoms in this syndrome and should be considered as a potentially additive treatment to immunotherapy when rapid relief is sought.
我们描述了一名17岁男性的病例，他出现急性发作的癫痫以及伴有精神病、激越和代谢亢进的恶性紧张症，对电休克治疗（ECT）有反应。在他开始出现反应后不久，被诊断为抗N-甲基-D-天冬氨酸（NMDA）受体脑炎，随后接受了免疫抑制治疗。抗NMDA受体脑炎是一种越来越被认识到的自身免疫性疾病，常表现为神经精神症状。主要治疗方法包括早期诊断、若发现肿瘤则进行检查和切除，以及开始免疫抑制治疗。治疗反应通常较慢，残留症状常见。在本病例中，在抗NMDA受体脑炎的潜在诊断确立并开始标准治疗之前，ECT使病情得到了临床稳定。我们认为，ECT对于稳定该综合征中危及生命的神经精神症状可能非常有益，在寻求快速缓解时，应被视为免疫治疗的一种潜在辅助治疗方法。
