Catatonia due to anti-NM DA receptor encephalitis in a 7-year-old male
Location
LSUHSC-NO
Publication Date
April 2026
Start Date
9-4-2026 10:00 AM
End Date
9-4-2026 2:00 PM
Description
Anti-NM DA receptor encephalitis is an autoimmune condition associated with neuropsychiatric symptoms, including agitation, mania, psychosis, and mood changes. Catatonia is a well-recognized but under-characterized neuropsychiatric complication of anti-NM DAR encephalitis in children. It has a prevalence of0.6-17.7% in children and adolescents. In previously reported pediatric cases, the literature largely describes the use of ECT in patients with catatonia refractory to firstline benzodiazepine therapy and aggressive immunomodulatory treatment.
Here, we describe the case of a 7-year-old boy with a history of ADHD, ODD, prematurity, in-utero polysubstance exposure and speech delay who was diagnosed with anti-NM DA receptor encephalitis and subsequently developed severe and prolonged catatonia despite aggressive immunotherapy, resulting in a 4 month-long hospital stay. He required prolonged high-dose scheduled benzodiazepine treatment with careful titration and frequent reassessment using the Bush-Francis Catatonia Rating Scale. His course was further complicated by prominent choreiform and dystonic movements, encephalopathy, gastrointestinal complications requiring parenteral nutrition, and concern for impaired enteral medication absorption. His care required a multidisciplinary approach involving psychiatry, neurology, pediatrics, and physical medicine and rehabilitation. Formal consultation for ECT was obtained due to refractory symptoms; however, it was deferred due to medical instability, limited availability of pediatric ECT services at his age, family preference, and gradual improvement with continued benzodiazepine titration. Over several weeks, his catatonic symptoms slowly improved, with persistent but diminishing mutism and rigidity at discharge.
Notably, this case demonstrates a prolonged and fluctuating course of catatonia persisting despite neurologic recovery and immunologic treatment, slowly improving with benzodiazepine titration and without ECT. It also highlights the diagnostic and therapeutic challenges created by overlapping movement disorders and encephalopathy. Finally, it demonstrates the importance of careful monitoring and characterization of symptoms over time, and benefits of multidisciplinary collaboration in the management of this condition.
Recommended Citation
Easwar, Sanjana MD; Scarton, Katherine BS; and Campbell, Megan DO, "Catatonia due to anti-NM DA receptor encephalitis in a 7-year-old male" (2026). Dept. of Psychiatry Research Symposium. 7.
https://digitalscholar.lsuhsc.edu/psych_rd/2026/posters/7
Catatonia due to anti-NM DA receptor encephalitis in a 7-year-old male
LSUHSC-NO
Anti-NM DA receptor encephalitis is an autoimmune condition associated with neuropsychiatric symptoms, including agitation, mania, psychosis, and mood changes. Catatonia is a well-recognized but under-characterized neuropsychiatric complication of anti-NM DAR encephalitis in children. It has a prevalence of0.6-17.7% in children and adolescents. In previously reported pediatric cases, the literature largely describes the use of ECT in patients with catatonia refractory to firstline benzodiazepine therapy and aggressive immunomodulatory treatment.
Here, we describe the case of a 7-year-old boy with a history of ADHD, ODD, prematurity, in-utero polysubstance exposure and speech delay who was diagnosed with anti-NM DA receptor encephalitis and subsequently developed severe and prolonged catatonia despite aggressive immunotherapy, resulting in a 4 month-long hospital stay. He required prolonged high-dose scheduled benzodiazepine treatment with careful titration and frequent reassessment using the Bush-Francis Catatonia Rating Scale. His course was further complicated by prominent choreiform and dystonic movements, encephalopathy, gastrointestinal complications requiring parenteral nutrition, and concern for impaired enteral medication absorption. His care required a multidisciplinary approach involving psychiatry, neurology, pediatrics, and physical medicine and rehabilitation. Formal consultation for ECT was obtained due to refractory symptoms; however, it was deferred due to medical instability, limited availability of pediatric ECT services at his age, family preference, and gradual improvement with continued benzodiazepine titration. Over several weeks, his catatonic symptoms slowly improved, with persistent but diminishing mutism and rigidity at discharge.
Notably, this case demonstrates a prolonged and fluctuating course of catatonia persisting despite neurologic recovery and immunologic treatment, slowly improving with benzodiazepine titration and without ECT. It also highlights the diagnostic and therapeutic challenges created by overlapping movement disorders and encephalopathy. Finally, it demonstrates the importance of careful monitoring and characterization of symptoms over time, and benefits of multidisciplinary collaboration in the management of this condition.