(Kiosk 4) Rehabilitation of Limbic Encephalitis with Psychiatric Features: A Case Report and Review of the Literature

Case Diagnosis: Limbic Encephalitis with Psychiatric Features

Case Description or Program Description: The patient was a 28 y.o. female with past medical history of asthma, depression, GAD, seizure like event, and spontaneous abortion due to antiphospholipid syndrome, who was admitted to an acute care hospital with seizures and bilateral temporal lobe signal changes on MRI that were concerning for limbic encephalitis. EEG showed focal slowing in frontotemporal regions bilaterally with intermixed epileptiform discharges concerning for possible untreated temporal lobe seizure disorder. She was started on methylprednisolone 1 g IV daily for 5 days with positive response. EEG confirmed no seizure activity. However, the patient continued to have repeat episodes of dizziness, back/hip pain, and seizure like episodes. It was felt that many of these episodes were psychiatric in nature and part of an overall Functional neurologic disorder (FND) with non-epileptic seizures. An autoimmune panel of her CSF reveled that she was GAD65 antibody positive. She was admitted to our rehabilitation center 10 days after her admission into acute care. During her admission, she participated in an intense therapy program including physical therapy, occupational therapy, speech therapy, and sessions with a rehabilitation psychologist. Pharmacologic management included quetiapine for agitation and anxiety, and scopolamine patch for vertigo.

Setting: Acute Inpatient Rehabilitation

Assessment/Results: Following an 8 day stay she showed improvements with her mobility, independence with her activities of daily living, and cognition. She also showed improvement in her emotional state. Following her 8 day stay at our facility she was discharged home with family.

Discussion (relevance): The multidisciplinary approach by using pharmacological treatments, as well as motor and cognitive therapies were important in helping the patient’s recovery.

Conclusions: After reaching her inpatient rehabilitation objectives, the patient was referred to physical therapy, occupational therapy, and speech and language therapy, and was encouraged to engage in CBT psychotherapy to continue to optimize her recovery.