Electroconvulsive therapy for anti-N-methyl-d-aspartate (NMDA) receptor encephalitis: a systematic review of cases

Anti-NMDA receptor encephalitis most commonly presents with psychiatric symptoms such as behavioural disturbance, catatonia and psychosis. Although the primary treatment is with immunomodulatory therapy, psychiatric symptoms often require adjuvant management. Side effects and treatment resistance limits the use of psychotropics, but the role of ECT has been minimally reviewed. To review the safety and effectiveness of ECT for treatment of psychiatric symptoms in anti-NMDA receptor encephalitis. A systematic literature review of PubMed, Embase and PsycInfo was performed from inception to June 2018. There were 30 cases of ECT used in anti-NMDA receptor encephalitis. Cases were typically young (mean age 27.7 years, SD 15.2) females (73.3%) with catatonia (86.7%). There was improvement of these symptoms in 65.2% of cases, interestingly without immunomodulatory therapy in 17.4%. ECT proceeded without complication in 86.7% of cases, with four cases prematurely ceasing ECT with further encephalitic deterioration. There were no anaesthetic complications. ECT appears to be an effective and safe adjuvant treatment in anti-NMDA receptor encephalitis, particularly for catatonia.