Treatment of Anti-NMDA-Receptor Encephalitis with Severe Catatonia (BFCRS ≥ 4 Items) and Autonomic Instability

Anti-NMDA-receptor encephalitis can present with a high-acuity catatonic syndrome. When four or more items on the Bush-Francis Catatonia Rating Scale each score greater than zero alongside severe autonomic instability, this specific combination defines a clinical situation requiring an urgent, structured escalation pathway.

Defining Clinical Criteria

4 or more Bush-Francis Catatonia Rating Scale (BFCRS) items each scoring > 0
Severe autonomic instability present

Management Approach

This presentation warrants immediate specialist consultation for an advanced intervention, combined with urgent escalation of the care setting. The complete protocol specifies the full sequence, criteria, and decision pathway.

Instant Access to Structured Evidence-Based Regimens

References

DOI: 10.1212/CPJ.0000000000200218

Total of 4 or more BFCRS items with a score > 0?
Severe autonomic instability?
Urgent ECT consult and admit to PICU

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