Treatment agression and autism following viral encephalitis

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Treatment of Viral Encephalitis Organic Personality Disorder and Autistic

Features with Propranolol: A Case Report

G. Schmidt Department of Physical Medicine and Rehabilitation, Brain

Injury Rehabilitation Program, St. 's Hospital, Rochester, New York,

Department of Neurology, University of Rochester School of Medicine and

Dentistry, Rochester, New York, Premier Care Neurorehabilitation Program,

Bethesda General Hospital, St. Louis, Missouri, Department ofNeurology, St.

Louis University School of Medicine, St. Louis, Missouri L. Dombovy

Department of Physical Medicine and Rehabilitation, Brain Injury

Rehabilitation Program, St. 's Hospital, Rochester, New York, Department

of Neurology, University of Rochester School of Medicine and Dentistry,

Rochester, New York Kimberlee Watkins Premier Care Neurorehabilitation

Program, Bethesda General Hospital, St. Louis, Missouri Objective : To

observe and describe the clinical effects of propranolol in an agitated and

violent patient with postviral encephalitis organic personality disorder.

Background: Cognitive and behavioral deficits are common in patients with

viral encephalitis. Meth ods to modify behavior by a behavior program and

medication have reported limited success. Case: A sixteen-year-old girl

developed progressive violent and sexually dis inhibited behavior five weeks

following acute viral encephalitis (presumed herpes sim plex encephalitis).

Three weeks of high dose lorazepam (6mg/d) failed to control her symptoms.

Intensive behavioral therapy was also ineffective and violent behavior

increased during structured treatment hours. Benzodiazepines and low dose

haloperidol were ineffective over the subsequent two weeks in a

neurorehabilitation unit. Propra nolol was then given (10 mg b.i.d. to 20 mg

t.i.d.) and she had a dramatic change in behavior with less violence and

less agitation after one day of treatment with propra nolol. Her short-term

memory improved. Decreased dosage of propranolol was associ ated with the

return of violent behavior. Maintenance propranolol was effective in con

trolling her symptoms and led to the resumption of her multidisciplinary

rehabilitation program. Conclusion: Violent and autistic behavior due to

viral (herpes) encephalitis may respond to propranolol. Key Words:

Propranolol‹Viral encephalitis‹Organic personality disorder‹Autism.

Neurorehabilitation and Neural Repair, Vol. 9, No. 1, 41-45 (1995)