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Abstract Details

ECT in NMDAR Encephalitis: A Retrospective Cohort and Systematic Review of Literature
Autoimmune Neurology
P6 - Poster Session 6 (8:00 AM-9:00 AM)
14-006

To evaluate safety and utility of electroconvulsive therapy (ECT) in patients with NMDARE through a systematic literature review and a retrospective, multi-center cohort. 

Neuropsychiatric symptoms in NMDARE are often severe and difficult to treat, leading some to pursue empiric trials of ECT, despite unclear safety and efficacy in NMDARE patients.

Systematic review: PubMed and Embase databases were searched to identify 37 articles describing 39 patients with NMDARE undergoing ECT. Retrospective cohort analysis: clinical information from a previously identified cohort of 577 patients with NMDARE was reviewed to identify 21 patients undergoing ECT. 

Systematic review: We identified 39 cases of NMDARE patients receiving ECT during their acute illness. Good clinical improvement was attributed to ECT in 12 cases (31%), partial or equivocal improvement in 7 cases (18%), and no improvement in 3 cases (8%). Worsening of clinical course following ECT was reported in 11 patients (28%). Clinical response following ECT was not described in 6 cases.  

Retrospective cohort: We identified a cohort of 21 cases of NMDARE patients receiving ECT during their acute illness. A good response to ECT was noted in 2 patients (10%), partial or equivocal in 2 patients (10%), no improvement in 5 patients (24%), and worsening of clinical course following ECT was seen in 8 (38%) of patients. Clinical response following ECT was not available for 4 patients. 

We present a systematic review of patients with NMDARE receiving ECT, as well as a multicenter, retrospective cohort of NMDARE patients undergoing ECT. We conclude that there is currently not sufficient data supporting a beneficial effect of ECT in NMDARE. Confounding factors, including concurrent immunotherapy use, make interpretation of available cases challenging. In patients with worsening clinical courses following ECT, immunotherapies had not been given, underscoring the essential need to prioritize diagnosis and treatment of the underlying disease. 
Authors/Disclosures
Melissa A. Wright, MD (University of Utah)
PRESENTER 		Dr. Wright has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Novartis .
Mar Guasp, MD (Hospital Clínic Barcelona - IDIBAPS) Dr. Guasp has nothing to disclose.
Christian Lachner Christian Lachner has received personal compensation in the range of $500-$4,999 for serving as a Consultant for PeerView. Christian Lachner has received personal compensation in the range of $500-$4,999 for serving as a Consultant for PSL Group Services.
Gregory S. Day, MD, MSc, FAAN (Mayo Clinic) Dr. Day has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Arialys Therapeutics. Dr. Day has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for DynaMed (EBSCO Health). Dr. Day has or had stock in ANI Pharmaceuticals. The institution of Dr. Day has received research support from National Institutes of Health / NIA. The institution of Dr. Day has received research support from National Institutes of Health / NINDS. The institution of Dr. Day has received research support from Amgen Pharmaceuticals. The institution of Dr. Day has received research support from AVID Radiopharmaceuticals. Dr. Day has received personal compensation in the range of $500-$4,999 for serving as a Presenter at Annual Meeting (CME) with 好色先生. Dr. Day has received personal compensation in the range of $500-$4,999 for serving as a Content Development (CME) with PeerView, Inc. Dr. Day has received personal compensation in the range of $5,000-$9,999 for serving as a Content Development (CME) with Continuing 好色先生, Inc. Dr. Day has received personal compensation in the range of $5,000-$9,999 for serving as a Content Development (CME) with Ionis Pharmaceuticals. Dr. Day has received personal compensation in the range of $500-$4,999 for serving as a 好色先生al Case Development + Presentation (video) with PeerDirect (P\S\L Group). Dr. Day has received personal compensation in the range of $500-$4,999 for serving as a Content Development / Presentation (non-CME) with MJH Life Sciences (NeurologyLive). Dr. Day has a non-compensated relationship as a Clinical Director with Anti-NMDA Receptor Encephalitis Foundation that is relevant to AAN interests or activities.
Grace Gombolay, MD, FAAN (Emory University/Children'S Healthcare of Atlanta) The institution of Dr. Gombolay has received research support from CDC. The institution of Dr. Gombolay has received research support from NIH.
Maarten J. Titulaer, MD, PhD (Erasmus Medical Center) The institution of Dr. Titulaer has received research support from Dutch Epilepsy Foundations (NEF 19-08). The institution of Dr. Titulaer has received research support from CSL Behring. The institution of Dr. Titulaer has received research support from UCB. The institution of Dr. Titulaer has received research support from Netherlands Organisation for Scientific Research (ZonMW, Memorabel initiative and E-RARE UltraAIE) . The institution of Dr. Titulaer has received research support from Horizon Therapeutics / Amgen. The institution of Dr. Titulaer has received research support from Dioraphte (charity). The institution of Dr. Titulaer has received research support from Guidepoint Global LLC. The institution of Dr. Titulaer has received research support from ArgenX. Dr. Titulaer has received intellectual property interests from a discovery or technology relating to health care. Dr. Titulaer has received publishing royalties from a publication relating to health care.
Stacey Clardy, MD, PhD, FAAN (University of Utah) Dr. Clardy has received personal compensation for serving as an employee of Veterans Health Administration (VHA). Dr. Clardy has received personal compensation for serving as an employee of University of Utah Health. Dr. Clardy has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for AstraZeneca/Alexion. Dr. Clardy has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Amgen/Horizon. Dr. Clardy has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Arialys. Dr. Clardy has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Kyverna. Dr. Clardy has received personal compensation in the range of $10,000-$49,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Neurology/AAN Publications. The institution of Dr. Clardy has received research support from NIH/NINDS. The institution of Dr. Clardy has received research support from SRNA. The institution of Dr. Clardy has received research support from Alexion/AstraZeneca. Dr. Clardy has received personal compensation in the range of $500-$4,999 for serving as a AAN Summer Meeting CoDirector Travel and Lodging with AAN. Dr. Clardy has received personal compensation in the range of $500-$4,999 for serving as a Grand Rounds Travel/Lodging/Honoraria with U of Iowa, Miami, Stanford, Barrow, Beaumont Health, CCF, Emory, Penn State, Mayo Clinic, Walter Reed.