Introduction Autoimmune encephalitis (AE) is an inflammatory condition which may present with encephalopathy, including psychiatric symptoms of psychosis and catatonia. When catatonia becomes life-threatening or refractory to medication, electroconvulsive therapy (ECT) should be considered. This case series represents a compilation of patient care experiences in which ECT served as a highly effective augmentation strategy for catatonia associated with autoimmune encephalitis other than NMDA AE. Methods We performed a retrospective case-study analysis of four patients with autoimmune encephalitis and catatonia who had disease onset prior to the age of 18. Cases were selected from the patients evaluated by the child psychiatry consultation and liaison inpatient service (n=460) in which care overlapped with both the autoimmune brain disease program (n=35) and the ECT program (n=4). Retrospective chart review focused on Bush Francis Catatonia Rating Scores, medication treatments targeting catatonia, ECT protocols, and special ethical considerations in patient care. Results Significant improvement in features of catatonia as evaluated by the Bush Francis Catatonia Rating Score (BFCRS) were seen in each patient treated with ECT. Across these four cases we encountered special considerations related to ECT that were specific to pediatric auto-immune catatonia. Conclusions We recommend ECT as a part of the treatment plan for patients who present with refractory features of catatonia (i.e. non-medication responsive). We advocate for following established practice parameters for the use of ECT in adolescents, with proposed modifications for patients with catatonia from this cause who often present with an increased level of medical complexity.

中文翻译：

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电休克疗法治疗非 NMDA 自身免疫性脑病和紧张症：儿科病例系列和治疗指南

介绍 自身免疫性脑炎 (AE) 是一种炎症性疾病，可能表现为脑病，包括精神病和紧张症的精神症状。当紧张症危及生命或药物治疗无效时，应考虑电休克疗法 (ECT)。该病例系列代表了患者护理经验的汇编，其中 ECT 作为与 NMDA AE 以外的自身免疫性脑炎相关的紧张症的高效增强策略。方法 我们对 4 名 18 岁之前发病的自身免疫性脑炎和紧张症患者进行了回顾性病例研究分析。病例选自儿童精神病学咨询和联络住院服务 (n=460) 评估的患者，其中护理与自身免疫性脑病计划 (n=35) 和 ECT 计划 (n=4) 重叠。回顾性图表审查侧重于 Bush Francis Catatonia 评分、针对紧张症的药物治疗、ECT 协议以及患者护理中的特殊伦理考虑。结果 根据 Bush Francis Catatonia Rating Score (BFCRS) 的评估，在每名接受 ECT 治疗的患者中都观察到了紧张症特征的显着改善。在这四个案例中，我们遇到了与 ECT 相关的特殊考虑因素，这些考虑因素专门针对小儿自身免疫性紧张症。结论 我们建议将 ECT 作为治疗计划的一部分，用于出现难治性紧张症（即 非药物反应）。我们提倡遵循既定的在青少年中使用 ECT 的实践参数，并建议对因该原因引起的紧张症患者进行修改，这些患者通常表现出更高的医疗复杂性。