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Case report
Complete cognitive recovery in a severe case of anti-N-methyl-d-aspartate receptor encephalitis treated with electroconvulsive therapy
  1. Cæcilie Leding1,
  2. Lisbet Marstrand2 and
  3. Anders Jorgensen1,3
  1. 1Psychiatric Center Copenhagen, Rigshospitalet, Mental health services in the Capital Region of Denmark, Copenhagen, Denmark
  2. 2Department of Neurology, Rigshospitalet, Copenhagen, Denmark
  3. 3Institute of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
  1. Correspondence to Dr Anders Jorgensen; anders.01.joergensen{at}regionh.dk

Abstract

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.

  • psychiatry
  • delirium
  • neurology
  • memory disorders
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Footnotes

  • Contributors CL wrote the first draft of the paper. LM cowrote the paper and performed the neuropsychological tests. AJ wrote the final version of the paper. All authors have contributed to and approved the final version of the paper.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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