Some patients with advanced malignancies also have reversible catatonia or limbic encephalitis

Joseph Martin Alisky


Two potentially treatable disorders, paraneoplastic catatonia and paraneoplastic limbic encephalitis, may be hidden within the presentation of end stage cancer patients, because catatonia and limbic encephalitis usually feature severely altered mental status, confusion, anorexia, and minimal responsiveness that are also common with people dying of cancer. If catatonia and limbic encephalitis are correctly diagnosed and treated, there should be definite and dramatic improvement that would translate into better quality of life and perhaps even resumption of cancer therapy. This editorial reviews basic features of catatonia and limbic encephalitis, and then presents a strategy to systematically screen for these in end stage cancer patients who are about to enter hospice. A protocol is outlined that could be adapted for clinical practice or for designing clinical studies.


Catatonia; Limbic Encephalitis; Anti NMDA-receptor Encephalitis

Full Text:



Alisky JM. Is the immobility of advanced dementia a form of lorazepam-responsive catatonia? Am J Alzheimers Dis Other Demen. 2004; 19:213-4.

Bush G, Fink M, Petrides G, Dowling F, Francis A.Catatonia. I. Rating scale and standardized examination. Acta Psychiatr Scand. 1996; 93:129-36.

Mastain B, Vaiva G, Guerouaou D, et al. Favourable effect of zolpidem on catatonia. [Article in French]. Rev Neurol (Paris) 1995; 151:52-6.

Prowler ML, Weiss D, Caroff SN. Treatment of catatonia with methylphenidate in an elderly patient with depression. Psychosomatics. 2010; 51:74-6.

Neuhut R, Levy R, Kondracke A. Resolution of catatonia after treatment with stimulant medication in a patient with bipolar disorder. Psychosomatics. 2012; 53:482-4.

McDaniel WW, Spiegel DR, Sahota AK. Topiramate effect in catatonia: a case series. J Neuropsychiatry Clin Neurosci. 2006; 18:234-8.

Krüger S, Bräunig P. Intravenous valproic acid in the treatment of severe catatonia. J Neuropsychiatry Clin Neurosci. 2001; 13:303-4.

Carroll BT, Goforth HW, Thomas C, et al. Review of adjunctive glutamate antagonist therapy in the treatment of catatonic syndromes. J Neuropsychiatry Clin Neurosci. 2007; 19:406-12.

Grenier E, Ryan M, Ko E, et al. Risperidone and lorazepam concomitant use in clonazepam refractory catatonia: a case report. J Nerv Ment Dis. 2011; 199:987-8.

Roberto AJ, Pinnaka S, Mohan A, et al. Adolescent catatonia successfully treated with Lorazepam and aripiprazole. Case Rep Psychiatry. 2014; 2014: 309517.

Shukla L, Narayanaswamy JC, Gopinath S, Math SB. Electroconvulsive therapy for the treatment of organic catatonia due to viral encephalitis. J ECT. 2012; 28:e27-8.

Snyder S, Prenzlauer S, Maruyama N, Rose DN. Catatonia in a patient with AIDS-related dementia. J Clin Psychiatry. 1992; 53:414.

Scamvougeras A, Rosebush PI. AIDS-related psychosis with catatonia responding to low-dose lorazepam. J Clin Psychiatry. 1992 53:414-5.

Sheline YI, Miller MB. Catatonia relieved by oral diazepam in a patient with a pituitary microadenoma. Psychosomatics. 1986; 27:860-2.

Waller K, Borik A, Choi C. Breast cancer, bipolar disorder, catatonia, and life-preserving electroconvulsive therapy. Psychosomatics. 2000; 41:442-5.

Tandon R, Walden M, Falcon S. Catatonia as a manifestation of paraneoplastic encephalopathy. J Clin Psychiatry. 1988 49:121-2.

Gultekin SH, Rosenfeld MR, Voltz R, et al. Paraneoplastic limbic encephalitis: neurological symptoms, immunological findings and tumour association in 50 patients. Brain. 2000; 123:1481-94.

Graus F, Keime-Guibert F, Reñe R, et al. Anti-Hu-associated paraneoplastic encephalomyelitis: analysis of 200 patients. Brain 2001; 124:1138-48.

Machado S, Pinto AN, Irani SR. What should you know about limbic encephalitis? Arq Neuropsiquiatr. 2012; 70:817-22.

Shimazaki H, Ando Y, Nakano I, Dalmau J. Reversible limbic encephalitis with antibodies against the membranes of neurones of the hippocampus. BMJ Case Rep. 2009;2009.

Mann A, Machado NM, Liu N, et al. A multidisciplinary approach to the treatment of anti-NMDA-receptor antibody encephalitis: a case and review of the literature. J Neuropsychiatry Clin Neurosci. 2012; 24:247-54.

R Graus F, Saiz A, Dalmau J. Antibodies and neuronal autoimmune disorders of the CNS. J Neurol. 2010;257:509-17

Kaestner F, Mostert C, Behnken A, et al. Therapeutic strategies for catatonia in paraneoplastic encephalitis. World J Biol Psychiatry. 2008;9:236-40.

Lee EM, Kang JK, Oh JS, et al. 18F-Fluorodeoxyglucose Positron-Emission Tomography Findings with Anti-N-Methyl-D- Aspartate Receptor Encephalitis that Showed Variable Degrees of Catatonia: Three Cases Report. J Epilepsy Res. 2014;4:69-73.

Braakman HM, Moers-Hornikx VM, Arts BM, et al. Pearls & Oy-sters: electroconvulsive therapy in anti-NMDA receptor encephalitis. Neurology. 2010;75:e44-6.

Kruse JL, Jeffrey JK, Davis MC, Dearlove J, IsHak WW, Brooks JO 3rd. Anti-N-methyl-D-aspartate receptor encephalitis: a targeted review of clinical presentation, diagnosis, and approaches to psychopharmacologic management. Ann Clin Psychiatry. 2014;26:111-9.

Leypoldt F, Buchert R, Kleiter I, et al. Fluorodeoxyglucose positron emission tomography in anti-N-methyl- D-aspartate receptor encephalitis: distinct pattern of disease. J Neurol Neurosurg Psychiatry. 2012; 83:681-6.

Padma S, Sundaram PS, Marmattom BV. PET/CT in the evaluation of anti-NMDA-receptor encephalitis: What we need to know as a NM physician. Indian J Nucl Med. 2011; 26:99-101.

Kamble N, Netravathi M, Saini J et al. Clinical and imaging characteristics of 16 patients with autoimmune neuronal synaptic encephalitis. Neurol India. 2015; 63:687-96.

Endres D, Perlov E, Baumgartner A, et al. Immunological findings in psychotic syndromes: a tertiary care hospital's CSF sample of 180 patients. Front Hum Neurosci. 2015;9:476.

Rasmussen KG, Perry CL, Sutor B, Moore KM. ECT in patients with intracranial masses. J Neuropsychiatry Clin Neurosci. 2007; 19:191-3.

Teraishi T, Nakatake M, Hirano J, et al. Electroconvulsive therapy and meningioma: a brief review. Nihon Shinkei Seishin Yakurigaku Zasshi. 2012; 32:57-61.

Dan A, Grover S, Chakrabarti S. Knowledge and Attitude of Patients with Psychiatric Disorders and their Relatives Toward Electroconvulsive Therapy. Indian J Psychol Med. 2014; 36:264-9.


Creative Commons License
This work is licensed under a Creative Commons Attribution 3.0 License.


International Journal of Cancer Therapy and Oncology (ISSN 2330-4049)

© International Journal of Cancer Therapy and Oncology (IJCTO)

To make sure that you can receive messages from us, please add the '' domain to your e-mail 'safe list'. If you do not receive e-mail in your 'inbox', check your 'bulk mail' or 'junk mail' folders.


Number of visits since October, 2013