Catatonia in Limbic Encephalitis Treated with Electroconvulsive Therapy (P5.105)

OBJECTIVE: Describe the clinical presentation and treatment, including electroconvulsive therapy (ECT), in a patient with limbic encephalitis-related catatonia. BACKGROUND: Limbic encephalitis is a disorder characterized by acute-subacute onset of cognitive impairment, psychiatric disturbances, or seizures with evidence of medial temporal lobe and limbic system pathology. Onconeuronal and cell surface antigen antibodies have been identified, but seronegative cases have been reported. In paraneoplastic cases, there may be improvement when malignancy is treated early. Autoimmune limbic encephalitis is treated immunologically, with methylprednisolone, IVIG, or plasmapheresis. DESIGN/METHODS: We report the case of a 74 year old previously healthy female who presented to our hospital for sudden onset of expressive aphasia. During her hospitalization, she progressed to akinetic mutism with paratonia. MRI Brain with contrast was significant for subtle bilateral medial temporal lobe FLAIR hyperintensities without enhancement. FDG-PET Brain revealed prominent bilateral medial temporal lobe hypermetabolism. Continuous video EEG showed generalized period pattern and slowing, but no seizures. Malignancy screening and infectious workup were negative. No metabolic abnormalities were identified. CSF WBC, protein and glucose were normal. IgG index was elevated, but serological and CSF assays were unrevealing for paraneoplastic autoantibodies and autoimmune disease. RESULTS: Initially the patient was treated IV methylprednisolone for three days without improvement. For catatonia, she had a trial of lorazepam which resulted in lethargy; methylphenidate caused a slight improvement, speaking single words. Thereafter she was treated with IVIG without improvement. Two months later, she was admitted to psychiatric hospital with akinetic mutism and treated with ECT. She improved to speaking in complete sentences and eating independently. CONCLUSIONS: This is a case of seronegative limbic encephalitis presenting as catatonia that was refractory to steroids and IVIG. However, the patient responded to ECT. In refractory cases of catatonia in limbic encephalitis, ECT could be considered for symptomatic treatment. Disclosure: Dr. Mente has nothing to disclose. Dr. Kim has nothing to disclose. Dr. Rae-Grant has received personal compensation for activities with Novartis, Biogen Idec, and Teva Neurosciences as a speaker.