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• Vol.41 No.11
• CLINICA NEUROL, 41: 805−808, 2001
• Vol.41 No.11 contents

Case Report

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

Koichi Narikawa, M. D. , Takafumi Hasegawa, M. D. , Atsushi Takeda, M. D. , Yuusei Shiga, M. D. and Yasuto Itoyama, M. D.

Department of Neurology, Tohoku University School of Medicine

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 Klü ver-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.

(CLINICA NEUROL, 41: 805−808, 2001)
key words: imbic encephalitis, emotional disturbances, Klüver-Bucy syndrome, serotonin, SSRI

(Received: 19-Jan-01)