Autoimmume encephalitis is an important new potential indication for ECT. This recent review article is worth reading carefully:
Anti-N-Methyl d-Aspartate Receptor Encephalitis and Electroconvulsive Therapy: Literature Review and Future Directions
Child Adolesc Psychiatr Clin N Am, 28 (1), 79-89 Jan 2019 PMID: 30389078
The pdf is here.
This review might have escaped your attention because it appears in the child and adolescent psychiatry literature. The article has a comprehensive literature review of reported cases of ECT use in autoimmune encephalitis. It also has an excellent review of catatonia (which occurs in the vast majority of these patients) and a discussion of the potential mechanism of action of ECT in autoimmune encephalitis. Please see also bog posts of 2/8 and 3/23 on this topic.
This comment was sent in by Max Fink:
ReplyDeleteNMDAR, Catatonia, and the Role of ECT
In 2007, an acute onset systemic delirium, seizures, psychosis was associated with an abnormal blood test developed by the Philadelphia neurologist Dalmau; identified as NMDAR encephalitis, the first cases were associated with hidden tumors but the descriptions included prominent signs of catatonia. Treatments for catatonia were successful, including ECT.
Suddenly, in 13 years, medicine has a remarkable treatable diagnosis.
Two readings. Susannah Cahalan's BRAIN ON FIRE: My Month of Madness (2012, Simon & Schuster) is a remarkable description of the illness. She responded to systemic medical care.
The connection between catatonia and encephalitis is described in The Madness of Fear: A History of Catatonia (Shorter E, Fink M, Oxford 2018). Catatonia is an old syndrome (1874) that since 1980s has been rediscovered as an identifiable, verifiable, and treatable acute behavior syndrome.
The Fuchs essay is an excellent summary that will make ECT experts proud.
Max Fink