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Final Program

Spasticity / Movement Disorders

520 - Acute Rehab in a Case of NMDA Encephalitis

Friday, February 20, 2026
5:00 PM - 6:30 PM AST

    Co-Author(s)

  • RC

    Robert A. Castro, BA

    Medical Student
    Lewis Katz School of Medicine at Temple University
    Philadelphia, Pennsylvania, United States

  • NR

    Navpreet Reehal, BA

    Medical Student
    Lewis Katz School of Medicine at Temple University
    Philadelphia, Pennsylvania, United States

    • Presenting Author(s)

  • GH

    Gabriel Howard, DO

    Resident Physician
    Temple University Hospital
    Pipersville, Pennsylvania, United States

    • Submitter(s)

  • RC

    Robert A. Castro, BA

    Lewis Katz School of Medicine at Temple University
    Philadelphia, Pennsylvania, United States

Case Diagnosis: Anti-NMDA Receptor Encephalitis

Case Description: A 24-year-old female presented to the emergency department with acute onset of altered mental status, catatonia, and psychosis without clear psychiatric etiology following an infection with the flu about a week prior. Imaging and CSF analysis were consistent with NMDA encephalitis and diagnosis was confirmed by serum and CSF NMDA antibodies. The patient’s mental status improved with high-dose corticosteroids, therapeutic apheresis, rituximab, and tocilizumab therapy, although she remained with persistent catatonia as well as impaired mobility, ADLs, transfers, and cognition. High-dose amantadine therapy (200 mg BID) was initiated which alleviated her catatonia and helped improve her cognition. Additionally, physiatry recommended 3 hours daily of inpatient PT, OT, and SLP for 5 days/week until transition to acute rehabilitation was appropriate, which benefited the patient in the recovery of functional activities.

Discussions:

NMDA encephalitis predominantly presents in adolescents and young females with an acute onset of psychiatric manifestations such as catatonia, psychosis, agitation, and cognitive impairment after a prodrome of viral symptoms. As an NMDA receptor antagonist, high-dose amantadine therapy may be an effective supplemental treatment for persistent catatonia in patients with NMDA encephalitis, especially when the etiology is viral. Treatment should be combined with adjunctive rehabilitation including PT, OT, and SLP to help maximize the recovery of synaptic function and neural networks that are lost during the disruption of NMDA receptors. Acute rehabilitation is most likely to be effective during the first year after diagnosis while the brain’s neuroplasticity is most susceptible to recovery.

Conclusions:

High-dose amantadine and acute rehabilitation should be used as adjunctive therapy in patients with catatonia and functional impairment in the setting of NMDA encephalitis during the first year after diagnosis to maximize return to daily activities and functional independence.