A 22-year-old African woman developed acute behavioural change, against a background of sickle cell disease with strokes requiring a ventriculoperitoneal shunt. She alternated between mutism with prolonged staring and posturing, and a state of agitation with elation and echolalia. Cerebrospinal fluid (CSF) protein was elevated and electroencephalogram showed mild slowing with bitemporal slow and sharp waves. We suspected catatonia secondary to possible autoimmune encephalitis but her condition persisted despite intravenous methylprednisolone. After identifying a positive serum anti-gamma-aminobutyric acid-A (GABAA) antibody, treatment with intravenous immunoglobulin, oral corticosteroids and rituximab led to gradual improvement. Patients with catatonia may show reduced GABAA receptor density and there are two other reports of catatonia with anti-GABAA antibodies. This patient’s treatment response supports the antibody’s causative role.
- clinical neurology
- cognitive neuropsychology
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Contributors KS: neurology specialist registrar. JR: clinical fellow in neuropsychiatry. MM-R: consultant neurologist. BS: consultant neurologist. KS: wrote the manuscript with support from JR, MM-R and BS who contributed significantly to the concept and design, data collection, and review of the literature and manuscript for important intellectual content, and approved the final version.
Funding This study was funded by Health Services and Delivery Research Programme (grant number: ACF-2016-17-007).
Competing interests None declared.
Patient consent for publication Obtained.
Provenance and peer review Not commissioned. Externally peer reviewed by Sarosh Irani, Oxford, UK.