When Anti-NMDA-receptor encephalitis presents with significant catatonia — defined by a specific threshold on the Bush-Francis Catatonia Rating Scale — a structured, rating-guided treatment pathway applies. This protocol describes that approach for patients meeting the criteria below.
The patient has catatonia with 4 or more Bush-Francis Catatonia Rating Scale (BFCRS) items scoring greater than 0, and does not have severe autonomic instability.
This combination — a defined BFCRS threshold with the absence of severe autonomic instability — determines eligibility for this first-line protocol.
Management begins with a lorazepam challenge, followed by structured reassessment using the BFCRS at a set interval. The patient's response to the initial challenge directly determines next steps — including whether to proceed to a scheduled dosing regimen with ongoing daily BFCRS-guided titration.
The complete protocol — including dosing thresholds, titration algorithm, reassessment intervals, and the full decision pathway — is available via the link below.
Response to lorazepam, with measurable improvement demonstrated on daily Bush-Francis Catatonia Rating Scale assessment.
DOI: 10.1212/CPJ.0000000000200218