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Zhai J, Traebert M, Zimmermann K, Delaunois A, Royer L, Salvagiotto G, Carlson C, Lagrutta A. Comparative study for the IMI2-NeuroDeRisk project on microelectrode arrays to derisk drug-induced seizure liability. J Pharmacol Toxicol Methods 2023; 123:107297. [PMID: 37499956 DOI: 10.1016/j.vascn.2023.107297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 06/01/2023] [Accepted: 07/19/2023] [Indexed: 07/29/2023]
Abstract
INTRODUCTION In the framework of the IMI2-NeuroDeRisk consortium, three in vitro electrophysiology assays were compared to improve preclinical prediction of seizure-inducing liabilities. METHODS Two cell models, primary rat cortical neurons and human induced pluripotent stem cell (hiPSC)-derived glutamatergic neurons co-cultured with hiPSC-derived astrocytes were tested on two different microelectrode array (MEA) platforms, Maestro Pro (Axion Biosystems) and Multiwell-MEA-System (Multi Channel Systems), in three separate laboratories. Pentylenetetrazole (PTZ) and/or picrotoxin (PTX) were included in each plate as positive (n = 3-6 wells) and ≤0.2% DMSO was used as negative controls (n = 3-12 wells). In general, concentrations in a range of 0.1-30 μM were tested, anchored, when possible, on clinically relevant exposures (unbound Cmax) were tested. Activity thresholds for drug-induced changes were set at 20%. To evaluate sensitivity, specificity and predictivity of the cell models, seizurogenic responses were defined as changes in 4 or more endpoints. Concentration dependence trends were also considered. RESULTS Neuronal activity of 33 compounds categorized as positive tool drugs, seizure-positive or seizure-negative compounds was evaluated. Acute drug effects (<60 min) were compared to baseline recordings. Time points < 15 min exhibited stronger, less variable responses to many of the test agents. For many compounds a reduction and cessation of neuronal activity was detected at higher test concentrations. There was not a single pattern of seizurogenic activity detected, even among tool compounds, likely due to different mechanisms of actions and/or off-target profiles. A post-hoc analysis focusing on changes indicative of neuronal excitation is presented. CONCLUSION All cell models showed good sensitivity, ranging from 70 to 86%. Specificity ranged from 40 to 70%. Compared to more conventional measurements of evoked activity in hippocampal slices, these plate-based models provide higher throughput and the potential to study subacute responses. Yet, they may be limited by the random, spontaneous nature of their network activity.
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Affiliation(s)
- Jin Zhai
- Merck & Co., Inc., Rahway, NJ, USA
| | | | | | | | | | | | - Coby Carlson
- Fujifilm Cellular Dynamics, Inc., Madison, WI, USA
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Qubad M, Bittner RA. Second to none: rationale, timing, and clinical management of clozapine use in schizophrenia. Ther Adv Psychopharmacol 2023; 13:20451253231158152. [PMID: 36994117 PMCID: PMC10041648 DOI: 10.1177/20451253231158152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 01/24/2023] [Indexed: 03/31/2023] Open
Abstract
Despite its enduring relevance as the single most effective and important evidence-based treatment for schizophrenia, underutilization of clozapine remains considerable. To a substantial degree, this is attributable to a reluctance of psychiatrists to offer clozapine due to its relatively large side-effect burden and the complexity of its use. This underscores the necessity for continued education regarding both the vital nature and the intricacies of clozapine treatment. This narrative review summarizes all clinically relevant areas of evidence, which support clozapine's wide-ranging superior efficacy - for treatment-resistant schizophrenia (TRS) and beyond - and make its safe use eminently feasible. Converging evidence indicates that TRS constitutes a distinct albeit heterogeneous subgroup of schizophrenias primarily responsive to clozapine. Most importantly, the predominantly early onset of treatment resistance and the considerable decline in response rates associated with its delayed initiation make clozapine an essential treatment option throughout the course of illness, beginning with the first psychotic episode. To maximize patients' benefits, systematic early recognition efforts based on stringent use of TRS criteria, a timely offer of clozapine, thorough side-effect screening and management as well as consistent use of therapeutic drug monitoring and established augmentation strategies for suboptimal responders are crucial. To minimize permanent all-cause discontinuation, re-challenges after neutropenia or myocarditis should be considered. Owing to clozapine's unique efficacy, comorbid conditions including substance use and most somatic disorders should not dissuade but rather encourage clinicians to consider clozapine. Moreover, treatment decisions need to be informed by the late onset of clozapine's full effects, which for reduced suicidality and mortality rates may not even be readily apparent. Overall, the singular extent of its efficacy combined with the high level of patient satisfaction continues to distinguish clozapine from all other available antipsychotics.
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Affiliation(s)
- Mishal Qubad
- Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, University Hospital Frankfurt, Goethe University, Frankfurt am Main, Germany
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Godoy LD, Prizon T, Rossignoli MT, Leite JP, Liberato JL. Parvalbumin Role in Epilepsy and Psychiatric Comorbidities: From Mechanism to Intervention. Front Integr Neurosci 2022; 16:765324. [PMID: 35250498 PMCID: PMC8891758 DOI: 10.3389/fnint.2022.765324] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Accepted: 01/24/2022] [Indexed: 12/22/2022] Open
Abstract
Parvalbumin is a calcium-binding protein present in inhibitory interneurons that play an essential role in regulating many physiological processes, such as intracellular signaling and synaptic transmission. Changes in parvalbumin expression are deeply related to epilepsy, which is considered one of the most disabling neuropathologies. Epilepsy is a complex multi-factor group of disorders characterized by periods of hypersynchronous activity and hyperexcitability within brain networks. In this scenario, inhibitory neurotransmission dysfunction in modulating excitatory transmission related to the loss of subsets of parvalbumin-expressing inhibitory interneuron may have a prominent role in disrupted excitability. Some studies also reported that parvalbumin-positive interneurons altered function might contribute to psychiatric comorbidities associated with epilepsy, such as depression, anxiety, and psychosis. Understanding the epileptogenic process and comorbidities associated with epilepsy have significantly advanced through preclinical and clinical investigation. In this review, evidence from parvalbumin altered function in epilepsy and associated psychiatric comorbidities were explored with a translational perspective. Some advances in potential therapeutic interventions are highlighted, from current antiepileptic and neuroprotective drugs to cutting edge modulation of parvalbumin subpopulations using optogenetics, designer receptors exclusively activated by designer drugs (DREADD) techniques, transcranial magnetic stimulation, genome engineering, and cell grafting. Creating new perspectives on mechanisms and therapeutic strategies is valuable for understanding the pathophysiology of epilepsy and its psychiatric comorbidities and improving efficiency in clinical intervention.
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Affiliation(s)
- Lívea Dornela Godoy
- Department of Psychology, Faculty of Philosophy, Sciences and Letters of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil
| | - Tamiris Prizon
- Department of Neuroscience and Behavioral Sciences, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - Matheus Teixeira Rossignoli
- Department of Neuroscience and Behavioral Sciences, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - João Pereira Leite
- Department of Neuroscience and Behavioral Sciences, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
- João Pereira Leite,
| | - José Luiz Liberato
- Department of Neuroscience and Behavioral Sciences, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
- *Correspondence: José Luiz Liberato,
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Le DS, Su H, Liao ZL, Yu EY. Low-dose clozapine-related seizure: A case report and literature review. World J Clin Cases 2021; 9:5611-5620. [PMID: 34307616 PMCID: PMC8281419 DOI: 10.12998/wjcc.v9.i20.5611] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 04/07/2021] [Accepted: 05/20/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Treatment-resistant schizophrenia is a severe form of schizophrenia characterized by poor response to at least two antipsychotic drugs and is typically treated with clozapine. However, clozapine lowers the epileptic threshold, leading to seizures, which are severe side effects of antipsychotics that result in multiple complications. Clozapine-related seizures are generally considered to be dose-dependent and especially rare in the low-dose (150-300 mg/d) clozapine treated population. Due to clinical rarity, little is known about its clinical characteristics and treatment.
CASE SUMMARY A 62-year-old Chinese man with a 40-year history of treatment-resistant schizophrenia presented to the Emergency Department with symptoms of myoclonus, consciousness disturbance and vomiting after taking 125 mg clozapine. Upon admission, the patient had a suddenly generalized tonic-clonic seizure lasting for about half a minute with persistent disturbance of consciousness, fever, cough and bloody sputum, which was considered to be low-dose clozapine-related seizure. After antiepileptic and multiple anti-infection treatments, the patient was discharged without epileptic or psychotic symptoms.
CONCLUSION Our aim is to highlight the early prevention and optimal treatment of clozapine-related seizure through case analysis and literature review.
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Affiliation(s)
- Dan-Sheng Le
- The Second Clinical Medical College, Zhejiang Chinese Medicine University, Hangzhou 310051, Zhejiang Province, China
| | - Heng Su
- Department of Psychiatry, Zhejiang Provincial People’s Hospital, Hangzhou 310000, Zhejiang Province, China
| | - Zheng-Luan Liao
- Department of Psychiatry, Zhejiang Provincial People’s Hospital, Hangzhou 310000, Zhejiang Province, China
| | - En-Yan Yu
- Department of Psychiatry, The Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Institute of Basic Medicine and Cancer, Chinese Academy of Sciences, Hangzhou 310022, Zhejiang Province, China
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Augmentation of Antipsychotic Medications with Low-Dose Clozapine in Treatment-Resistant Schizophrenia-Case Reports and Discussion. Case Rep Psychiatry 2021; 2021:5525398. [PMID: 34239749 PMCID: PMC8235956 DOI: 10.1155/2021/5525398] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 05/05/2021] [Accepted: 06/04/2021] [Indexed: 11/18/2022] Open
Abstract
Treatment resistance in schizophrenia is often encountered in clinical practice, with clozapine usually recommended as the appropriate therapy. However, where clozapine proves ineffective or cannot be tolerated due to side effects, treatment options are limited. In patients within forensic mental health services, residual symptomatology often presents a barrier to discharge and can have lasting effects on prospects for rehabilitation as well as risk to self and others. This paper presents a review of the relevant literature and three cases of a novel approach, utilising clozapine in doses usually considered subtherapeutic, in combination with the primary antipsychotic treatment. In all three patients, it improved clinical efficacy as well as tolerability, resulting in improvement that allowed discharge from the forensic hospital.
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Schmitz A, Botner B, Hund M. Bupropion With Clozapine: Case Reports of Seizure After Coadministration. J Pharm Pract 2020; 34:497-502. [PMID: 32079452 DOI: 10.1177/0897190020904280] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Clozapine is more effective than other atypical antipsychotics for treatment resistant schizophrenia, but has serious side effects. Clozapine has an estimated cumulative seizure risk of 10% in patients treated for 3.8 years. Bupropion can also induce seizures and its estimated risk is 0.4% at recommended doses. While some risk factors for seizures are known, much remains unknown about predicting seizure risk. Cases: We present 2 cases of seizures in patients treated with clozapine and bupropion without a seizure history. In the first case, a patient with schizoaffective disorder treated with dual antipsychotic therapy had a witnessed generalized tonic-clonic seizure. With the exception of bupropion/naltrexone which was started 2.5 months prior for weight loss, she had not had any recent medication changes. In the second case, a patient with schizoaffective disorder was treated with clozapine and was prescribed bupropion SR for smoking cessation for an extended duration. He had cut back on cigarette use in the 2 months prior to reporting "spells." The neurologist's assessment was probable epileptic seizures which resolved after the bupropion was stopped and divalproex was started for seizure prophylaxis. CONCLUSION Clozapine and bupropion are known to lower the seizure threshold, but little information is available regarding the risk when used in combination. It is unclear whether these agents, when used in combination, have additive seizure risk or possible synergistic effects. Bupropion should be used cautiously in patients treated with clozapine. Safer agents that do not lower the seizure threshold should be utilized whenever possible.
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Affiliation(s)
- Allison Schmitz
- Pharmacy Department, 20057Fargo VA Health Care System, ND, USA
| | - Brandon Botner
- Pharmacy Department, 20057Fargo VA Health Care System, ND, USA
| | - Morris Hund
- Mental Health Department, 20057Fargo VA Health Care System, ND, USA
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Borah AJ, Kalita A, Dutta SK. Clozapine-induced seizure. Indian J Pharmacol 2020; 51:410-412. [PMID: 32029964 PMCID: PMC6984017 DOI: 10.4103/ijp.ijp_403_18] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Revised: 07/12/2019] [Accepted: 12/23/2019] [Indexed: 01/09/2023] Open
Abstract
There are very few reports which suggest an association between antipsychotic clozapine low dose and seizure. We report a case in which intial titration of low dose clozapine developed seizure. A 42-year-old female who did not have any history of seizure and had normal blood parameters and normal computed tomography brain at the baseline developed seizure while on clozapine 300 mg/day. Reduction of the dose of clozapine to 250 mg/day led to the return to baseline, with having another episode of seizure on again increasing the dose of clozapine, requiring tablet haloperidol 10 mg/day as an add-on therapy for normalization of behavioral problems. Later, clozapine was maintained on 250 mg/day, with no recurrence of seizure episodes. To conclude, this case report suggests that clozapine can rarely lead to seizure during the initial phase of titration of treatment.
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Affiliation(s)
- Ankur Jyoti Borah
- Department of Psychiatry, Lokopriya Gopinath Bordoloi Regional Institute of Mental Health, Tezpur, Assam, India
| | - Abhijit Kalita
- Department of Psychiatry, Lokopriya Gopinath Bordoloi Regional Institute of Mental Health, Tezpur, Assam, India
| | - Satya Kumar Dutta
- Department of Psychiatry, Lokopriya Gopinath Bordoloi Regional Institute of Mental Health, Tezpur, Assam, India
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Ochi S, Inoue S, Yoshino Y, Shimizu H, Iga JI, Ueno SI. Efficacy of Asenapine in Schizophrenia Resistant to Clozapine Combined with Electroconvulsive Therapy: A Case Report. CLINICAL PSYCHOPHARMACOLOGY AND NEUROSCIENCE 2019; 17:559-563. [PMID: 31671497 PMCID: PMC6852681 DOI: 10.9758/cpn.2019.17.4.559] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Revised: 10/22/2018] [Accepted: 11/19/2018] [Indexed: 11/18/2022]
Affiliation(s)
- Shinichiro Ochi
- Department of Neuropsychiatry, Ehime University Graduate School of Medicine, Toon, Japan
| | - Saori Inoue
- Department of Neuropsychiatry, Ehime University Graduate School of Medicine, Toon, Japan
| | - Yuta Yoshino
- Department of Neuropsychiatry, Ehime University Graduate School of Medicine, Toon, Japan
| | - Hideaki Shimizu
- Department of Neuropsychiatry, Ehime University Graduate School of Medicine, Toon, Japan
| | - Jun-ichi Iga
- Department of Neuropsychiatry, Ehime University Graduate School of Medicine, Toon, Japan
| | - Shu-ichi Ueno
- Department of Neuropsychiatry, Ehime University Graduate School of Medicine, Toon, Japan
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Abstract
BACKGROUND Negative myoclonus is rarely seen in the clinical setting. It can be involved in some central nervous system pathologies. It has also been observed after antipsychotic treatment. CASE REPORTS In this article, we will present 3 cases diagnosed with negative myoclonus in a 120-bed university-affiliated hospital within the past 7 years. Based on our clinical experience, it was observed that myoclonic jerk was a rare condition that started with suddenly dose changes. Patients showed good improvement in response to dose reduction. CONCLUSIONS Since the number of reported cases on negative myoclonus is limited, there is still a lack of well-established consensus on the management of this disease. It can be concluded that myoclonic jerk may be dose-dependent, sudden dose changes may be effective, anticonvulsants are not effective in all cases, and treatment can be achieved by reducing the dose.
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Ayaydın H, Bilgen Ulgar Ş. Control of seizures in a clozapine-treated schizophrenia patient, using valproate: a case report. PSYCHIAT CLIN PSYCH 2019. [DOI: 10.1080/24750573.2018.1468640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
Affiliation(s)
- Hamza Ayaydın
- Department of Child and Adolescent Psychiatry, Faculty of Medicine, Harran University, Urfa, Turkey
| | - Şermin Bilgen Ulgar
- Department of Child and Adolescent Psychiatry, Faculty of Medicine, Harran University, Urfa, Turkey
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Association between electroencephalogram changes and plasma clozapine levels in clozapine-treated patients. Int Clin Psychopharmacol 2019; 34:131-137. [PMID: 30855515 DOI: 10.1097/yic.0000000000000255] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This retrospective observational study was performed to investigate electroencephalogram abnormalities in clozapine-treated patients with refractory schizophrenia or bipolar disorder. The electroencephalogram and plasma clozapine and norclozapine levels in 71 patients were measured on the same day. Fifty-nine patients (85.9%) had a diagnosis of schizophrenia, and 12 patients (14.1%) had a diagnosis of bipolar disorder. The mean daily clozapine dose was 242.9 ± 105.5 mg (range 25-500 mg), and the mean plasma clozapine and norclozapine levels were 429.4 ± 264.1 and 197.8 ± 132.6 ng/ml, respectively. Twenty-five patients (35.2%) were taking valproate in combination with clozapine. electroencephalogram abnormalities were found in 51 (71.8%) patients. No patient reported clinical seizures. Plasma clozapine level was significantly associated with electroencephalogram abnormalities and was identified as a significant predictor of electroencephalogram abnormalities in a logistic regression analysis. The plasma norclozapine levels of patients taking both clozapine and valproic acid were significantly lower than those of patients treated with clozapine alone. These results demonstrate that electroencephalogram abnormalities are closely correlated with plasma clozapine levels. Valproate reduced plasma norclozapine levels. Simultaneous monitoring of electroencephalogram and plasma clozapine levels was useful for adjusting clozapine doses, improving clinical efficacy, and preventing the side effects of clozapine treatment.
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Yang P, Li L, Xia S, Zhou B, Zhu Y, Zhou G, Tu E, Huang T, Huang H, Li F. Effect of Clozapine on Anti-N-Methyl-D-Aspartate Receptor Encephalitis With Psychiatric Symptoms: A Series of Three Cases. Front Neurosci 2019; 13:315. [PMID: 31024238 PMCID: PMC6465601 DOI: 10.3389/fnins.2019.00315] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Accepted: 03/19/2019] [Indexed: 01/29/2023] Open
Abstract
The main clinical manifestations of anti-N-methyl-D-aspartate receptor (anti-NMDAR) encephalitis are acute or subacute seizures, cognition impairment, and psychiatric symptoms. Nowadays, the scheme of antipsychotic therapy for this disease has not been established. This study reports three cases of anti-NMDAR encephalitis with psychiatric symptoms. The anti-NMDAR antibodies in cerebrospinal fluid (CSF) and serum were positive. The psychiatric symptoms still existed after intravenous immunoglobulin (IVIG) treatment; thus, clozapine was used for antipsychotic therapy. Case 1 was a 37-year-old man who suffered from bad mood and suicide behaviors for 1 month. Hallucination and delusion still existed after IVIG treatment and hormone therapy, and the symptoms were relieved when given clozapine for 12 months. Case 2 was a 28-year-old man who was admitted to our hospital due to injuring other people and destructive behaviors for 2 days. He showed irritability, bad temper, declined cognition, and severe delusion of persecution after IVIG treatment and hormone therapy, but the psychiatric symptoms disappeared when given clozapine for 3 months. Case 3 was a 23-year-old man who suffered from headache and babbing for 7 days. Symptoms such as irritability, bad temper, babbing, and injuring other people still existed after IVIG treatment and hormone therapy, but they disappeared when given clozapine for 2 months. Therefore, we suggest that during the treatment of anti-NMDAR encephalitis with psychiatric symptoms, if the anti-NMDAR antibodies in CSF and serum were positive, and psychiatric symptoms could not be controlled after IVIG and hormone therapy, clozapine may work.
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Affiliation(s)
- Ping Yang
- Department of Psychiatry, Hunan Brain Hospital, Clinical Medical School, Hunan University of Chinese Medicine, Changsha, China
| | - Liang Li
- Provincial Key Laboratory of TCM Diagnostics, Hunan University of Chinese Medicine, Changsha, China
| | - Shuaishuai Xia
- Provincial Key Laboratory of TCM Diagnostics, Hunan University of Chinese Medicine, Changsha, China
| | - Bin Zhou
- Department of Psychiatry, Hunan Brain Hospital, Clinical Medical School, Hunan University of Chinese Medicine, Changsha, China
| | - Yong Zhu
- Department of Psychiatry, Hunan Brain Hospital, Clinical Medical School, Hunan University of Chinese Medicine, Changsha, China
| | - Gaoya Zhou
- Department of Psychiatry, Hunan Brain Hospital, Clinical Medical School, Hunan University of Chinese Medicine, Changsha, China
| | - Erwen Tu
- Department of Psychiatry, Hunan Brain Hospital, Clinical Medical School, Hunan University of Chinese Medicine, Changsha, China
| | - Tianhao Huang
- Shanghai Institute of Measurement and Testing Technology, Shanghai, China
| | - Huiyong Huang
- Provincial Key Laboratory of TCM Diagnostics, Hunan University of Chinese Medicine, Changsha, China
| | - Feng Li
- Provincial Key Laboratory of TCM Diagnostics, Hunan University of Chinese Medicine, Changsha, China.,School of Dentistry, University of California, Los Angeles, Los Angeles, CA, United States
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Kim SY, Um YH, Lim SC, Jeong JH. Limbic Encephalitis Manifesting as Selective Amnesia and Seizure-like Activity: A Case Report. CLINICAL PSYCHOPHARMACOLOGY AND NEUROSCIENCE : THE OFFICIAL SCIENTIFIC JOURNAL OF THE KOREAN COLLEGE OF NEUROPSYCHOPHARMACOLOGY 2018; 16:109-113. [PMID: 29397673 PMCID: PMC5810455 DOI: 10.9758/cpn.2018.16.1.109] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Revised: 07/18/2016] [Accepted: 07/26/2016] [Indexed: 12/29/2022]
Abstract
Limbic encephalitis (LE) is characterized by short-term memory loss, disorientation, agitation, seizures, and histopathological evidence of medial temporal lobe inflammation. Leucine-rich, glioma inactivated 1 (LGI-1) is an auto-antigen associated with LE. We report a 37-year-old male patient with LGI-1-related LE who presented with recurrent episodes of selective amnesia, seizure-like activity, confusion, and personality change. His symptoms were significantly improved with steroid therapy. Thorough differential diagnosis with consideration for autoimmune encephalitis should be in patients with presentation of symptoms, such as memory impairment, personality change and seizure-like activity, especially when other neurological diagnoses are excluded.
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Affiliation(s)
- So-Yeon Kim
- Department of Psychiatry, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Yoo Hyun Um
- Department of Psychiatry, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Sung Chul Lim
- Department of Neurology, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jong-Hyun Jeong
- Department of Psychiatry, College of Medicine, The Catholic University of Korea, Seoul, Korea
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