[Successful treatment of emotional disturbances following non-herpetic limbic encephalitis by serotonergic agents. A case report]

Rinsho Shinkeigaku. 2001 Nov;41(11):805-8.
[Article in Japanese]

Abstract

We report a 19-year-old woman who developed refractory status epilepticus due to non-herpetic limbic encephalitis. Because ordinary anti-epileptics were ineffective, general anesthesia under mechanical ventilation was begun with pentobarbital, midazolam, and propofol. After 4 months, we could finally discontinue the intravenous anesthetics. Then, she gradually became conscious and several weeks later, could communicate verbally. Simultaneously, she began to manifest psychomotor agitation and emotional incontinence mimicking Klüver-Bucy syndrome. Brain MRI revealed cortical atrophy in the fronto-temporal lobes and dilated anterior and inferior horns of the lateral ventricles. Dopamine blockers and benzodiazepines failed to resolve these emotional symptoms. Oral tandospirone (30 mg/day dose) was initiated and a partial regression was observed. The following administration of fluvoxamine (started with 12.5 mg/day and maintained with 75 mg/day) resulted in a dramatic improvement of her symptoms within 3 days. This clinical course suggests that impaired serotonergic neurotransmission plays a key role in her emotional disturbances and that its modulation by serotonergic agents is useful to relieve such symptoms.

Publication types

  • Case Reports
  • English Abstract

MeSH terms

  • Adult
  • Affective Symptoms / drug therapy*
  • Affective Symptoms / etiology
  • Female
  • Humans
  • Isoindoles
  • Limbic Encephalitis / complications*
  • Piperazines / therapeutic use*
  • Pyrimidines / therapeutic use*
  • Serotonin Receptor Agonists / therapeutic use*

Substances

  • Isoindoles
  • Piperazines
  • Pyrimidines
  • Serotonin Receptor Agonists
  • tandospirone