Panic Attacks and Anxiety Disorder in a Child with Autism Spectrum Disorder and ADHD Triggered by GAD65 Autoimmune Encephalitis

In this contribution, we present an 11-year-old girl previously known with a history of ADHD and Asperger's autism. Within few hours, the child became increasingly confused and agitated, and headaches and vomiting occurred. Reduced level of consciousness with sopor developed so that she was admitted to hospital. EEG showed generalized slow delta waves. Encephalitis was diagnosed by pleocytosis and protein elevation in the cerebrospinal fluid as well as the detection of GAD65-AK. Within a few days of methylprednisolone therapy, the patient recovered completely.

In addition to the above-mentioned underlying psychiatric disorders, an anxiety disorder had been diagnosed 9 months before hospitalization. This was complicated by almost daily occurrence of panic attacks over the past weeks. After treatment with methylprednisolone, the symptoms of ADHD and autism disorder persisted, but since then there have been no panic attacks.

The occurrence of subacute psychiatric symptoms is a typical finding of autoimmune encephalitis. Even in patients with an underlying psychiatric disease, new psychiatric symptoms can be caused by autoimmune encephalitis and thus be present independently of the underlying disease. Recognizing this is a major challenge for the treating physician. Autoimmune encephalitis with limbic encephalitis is a very rare disease in childhood. By presenting this case and taking a look at the literature on pediatric autoimmune encephalitis and psychiatric comorbidities, we would like to draw attention to this vulnerable patient group.

No conflict of interest has been declared by the author(s).

Publication History

Article published online:
28 October 2021