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
Statistics from Altmetric.com
If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.
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.
Read the full text or download the PDF:
Other content recommended for you
- Delayed LGI1 seropositivity in voltage-gated potassium channel (VGKC)-complex antibody limbic encephalitis
- LGI1, CASPR2 and related antibodies: a molecular evolution of the phenotypes
- Autoimmune encephalitis in the elderly: who to test and what to test for
- Anti-voltage-gated potassium channel complex antibody–mediated limbic encephalitis: a case report of a 53-year-old man admitted to intensive care psychiatric unit with psychotic mania
- LGI1 antibody encephalitis: acute treatment comparisons and outcome
- Stop testing for autoantibodies to the VGKC-complex: only request LGI1 and CASPR2
- Emergence of new-onset psychotic disorder following recovery from LGI1 antibody-associated limbic encephalitis
- Autoimmune encephalitis: proposed recommendations for symptomatic and long-term management
- Thymoma associated paraneoplastic encephalitis (TAPE), a potential cause of limbic encephalitis
- End of the bed (end of the video) diagnosis