Treatment of Viral Encephalitis Organic Personality Disorder and Autistic Features with Propranolol: A Case Report

Abstract

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. Methods to modify behavior by a behavior program and medication have reported limited success. Case: A sixteen-year-old girl developed progressive violent and sexually disinhibited behavior five weeks following acute viral encephalitis (presumed herpes simplex 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. Propranolol 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 propranolol. Her short-term memory improved. Decreased dosage of propranolol was associated with the return of violent behavior. Maintenance propranolol was effective in controlling 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.

Herpes simplex viral encephalitis with acute memory impairment and low cellular cerebrospinal fluid: A case report with systematic review literature

“…Of these, nine articles were not in English, and 15 did not meet the inclusion criteria of reporting an acute onset of memory dysfunction. Finally, we included 21 articles [8] , [9] , [10] , [11] , [12] , [13] , [14] , [15] , [16] , [17] , [18] , [19] , [20] , [21] , [22] , [23] , [24] , [25] , [26] , [27] , [28] reporting 22 cases in this review. The age of the patients ranged from 13 to 78, and 7 cases [9] , [10] , [14] , [18] , [19] , [22] , [28] were females as shown in the PRISMA figure ( Fig.…”

Pharmacologic Treatment of Cognitive Deficits and Hypersexuality Due to “Shaken-Baby Syndrome”

“…Two pediatric cases of viral encephalitis with Kluver-Bucy syndrome had successful resolution of hypersexuality with propranolol (26,27). The proposed mechanism of action for propranolol is a central blockade of an increased sympathomimetic action in beta-adrenergic receptor sites (28).…”

“…Beta-blockers have been used successfully to control behavior in other disorders, including psychiatric disease (24) and traumatic brain injury (25). Two pediatric cases of viral encephalitis with Kluver-Bucy syndrome had successful resolution of hypersexuality with propranolol (26,27). The proposed mechanism of action for propranolol is a central blockade of an increased sympathomimetic action in beta-adrenergic receptor sites (28).…”

Propranolol versus Other Selected Drugs in the Treatment of Various Types of Anxiety or Stress, with Particular Reference to Stage Fright and Post-Traumatic Stress Disorder

“…This medicine also may help children with ASD and EBAD improve their therapy outcomes by alleviating symptoms related to autonomic dysregulation and/or hyperarousal. A considerable reduction in aggression, organic brain dysfunction [ 108 , 109 , 110 ], and anxiety disorders [ 111 , 112 ] has been reported in adolescents with ASD [ 113 ]. Moreover, propranolol was found to be effective in reducing self-injurious behaviours (SIBs) in people with ASD [ 114 ].…”