Kraiter F Gabriela, May Dakota T, Slauer Ryan D, Abburi Nandini, Eckstein Christopher, Shah Suma, Komisar Jonathan R, Feigal Jacob P
Department of Neurology, Duke University School of Medicine, Durham, North Carolina, USA.
Department of Psychiatry & Behavioral Health, Duke University School of Medicine, Durham, North Carolina, USA.
BMJ Neurol Open. 2024 Nov 12;6(2):e000812. doi: 10.1136/bmjno-2024-000812. eCollection 2024.
Anti-N-methyl-D-aspartate (NMDA) receptor encephalitis has been recognised to present with the syndrome of catatonia. In severe cases dysautonomia is representative of malignant catatonia. The treatment with benzodiazepines (BZDs) and electroconvulsive therapy (ECT) may decrease morbidity and mortality in patients presenting with anti-NMDA receptor encephalitis and catatonia.
This is a retrospective case series of eight patients with anti-NMDA receptor encephalitis treated with ECT. We use clinical prediction scores (Clinical Assessment Scale for Autoimmune Encephalitis [CASE] and anti-NMDAR Encephalitis One-Year Functional Status scores) to compare expected outcomes and observed outcomes.
CASE scores in our group ranged between 5 and 19, with a mean score of 13.8 (median 15.5). NEOS scores ranged from 2 to 4, with a mean and median of 3. Of the eight patients, six had a favourable modified Rankin Score (0-2) at a follow-up of 8 to 12 months. Patients received an average of 29.9 ECT treatments in total.
Based on clinical prediction scores, this cohort had better than expected functional outcomes. We discuss the use of BZDs and ECT in these cases and propose a treatment algorithm for patients who present with catatonic syndrome in anti-NMDA receptor encephalitis.
抗N-甲基-D-天冬氨酸（NMDA）受体脑炎已被认为可表现为紧张症综合征。在严重病例中，自主神经功能障碍是恶性紧张症的典型表现。使用苯二氮䓬类药物（BZDs）和电休克治疗（ECT）可能会降低抗NMDA受体脑炎和紧张症患者的发病率和死亡率。
这是一项对8例接受ECT治疗的抗NMDA受体脑炎患者的回顾性病例系列研究。我们使用临床预测评分（自身免疫性脑炎临床评估量表[CASE]和抗NMDAR脑炎一年功能状态评分）来比较预期结果和观察结果。
我们组的CASE评分在5至19之间，平均评分为13.8（中位数为15.5）。NEOS评分在2至4之间，平均和中位数均为3。8例患者中有6例在8至12个月的随访中改良Rankin评分良好（0 - 2）。患者总共平均接受了29.9次ECT治疗。
基于临床预测评分，该队列的功能结局优于预期。我们讨论了在这些病例中BZDs和ECT的使用，并为抗NMDA受体脑炎中出现紧张症综合征的患者提出了一种治疗算法。
