Alternative treatment in adolescent with anti-NMDA receptor encephalitis catatonia

A 12-year-old adolescent diagnosed with Anti-N-Methyl-D-Aspartate receptor encephalitis (ANMDAE) with catatonia was successfully treated with a course of zolpidem after inadequate response and lack of tolerance to first-line treatments, including benzodiazepines and electroconvulsive therapy (ECT). ANMDAE is an immune-mediated disease comprising a complex neuro-psychiatric clinical presentation that can range from memory deficits, seizures, and psychosis, to malignant catatonia. Catatonia is a psychomotor disorder that can increase the risk of medical complications. Current catatonia treatment guidelines include the use of benzodiazepines followed by ECT. Benzodiazepines are highly effective to treat catatonia in adults, with lower remission rates in children and adolescents. However, there are no defined guidelines if a patient fails to respond to the aforementioned treatments. Other treatment options may include zolpidem. To our knowledge, there is little literature on the treatment of catatonia with zolpidem in adolescents with underlying neurological conditions such as ANMDAE. This brief report highlights the importance of early recognition and treatment of ANMDAE with catatonia. It also underscores the lack of treatment guidelines for adolescents treated with immunotherapy presenting catatonia refractory to treatment with benzodiazepines and ECT. Zolpidem may be an alternative treatment for catatonia for patients not responding or tolerating benzodiazepines or ECT.