This protocol covers the management of Anti-NMDA-receptor encephalitis in patients presenting with significant catatonic features — four or more items on the Bush-Francis Catatonia Rating Scale (BFCRS) scoring above zero, without severe autonomic instability — in whom a lorazepam challenge has not produced the expected clinical improvement.
Catatonia with 4 or more Bush-Francis Catatonia Rating Scale items scoring greater than 0, and no severe autonomic instability present.
A lorazepam challenge was the initial approach. The goal was a clear response reflected by improvement on daily Bush-Francis Catatonia Rating Scale assessment. That response was not achieved, establishing the basis for escalation to the next management step.
When catatonia with this degree of BFCRS involvement has not responded to lorazepam, the structured approach moves to a somatic intervention — an electroconvulsive therapy (ECT) consultation is involved. The complete decision pathway and all clinical criteria are available in the full protocol below.
DOI: 10.1212/CPJ.0000000000200218
Total of 4 or more BFCRS items with a score > 0?
Severe autonomic instability?
ECT consult
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