Agitation in autoimmune and infectious encephalitis: a comparative study of clinical course and management at the neurological intensive care unit

Objective: Neuropsychiatric symptoms are common at onset and throughout the course of acute encephalitis. Agitation, which describes a syndrome of excessive motor activity, poses a therapeutic challenge and may necessitate admission to the intensive care unit (ICU). Data about treatment of this condition at the ICU are limited. Background: To study management and short-term outcomes of patients with distinct etiologies of encephalitis treated at the neurological ICU for agitation. Design/Methods: We performed a retrospective chart review of encephalitis cases treated at our tertiary care center between 2009 and 2016. Results: We identified 98 cases, 43 patients required ICU admission. 22 patients (mean age 59 years (IQR 35–75), 59% male) were admitted for the management of agitation. Concomitant seizures were present in 7 patients. Rates of ICU admission differed for autoimmune (49%), unknown (33%) or infectious (21%) etiologies. The median duration of ICU stay was 7 days (IQR 3.75–17). Fifteen of the 22 (68%) patients were admitted directly to the ICU, 7 patients were transferred from neurological and psychiatric wards (22% and 9%, respectively). The median SAPS II score was 21 (IQR 14–31), and 7 patients required mechanical ventilation. Patients received various combinations of benzodiazepines, neuroleptic and anticonvulsive drugs. Anticonvulsive comedications were more frequent in patients with autoimmune encephalitis (P Conclusions: Agitation is a major cause of ICU admission in patients with acute encephalitis, predominantly autoimmune cases. The management commonly requires multiple medications of different drug classes. Short-term outcome may be unfavorable despite intensive care Disclosure: Dr. Sellner has nothing to disclose. Dr. Harutyunyan has nothing to disclose. Dr. Dunser has nothing to disclose. Dr. Rossini has nothing to disclose. Dr. Leitinger has nothing to disclose. Dr. Novak has nothing to disclose. Dr. Aichhorn has nothing to disclose. Dr. Trinka has received personal compensation for consulting, serving on a scientific advisory board, speaking, or other activities with UCB, Eisai, Novartis, Gerrot-Lannach, BIAL, Takeda, Biogen, Newbridge, Sunovion. Dr. Hauer has nothing to disclose.