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

John G. Schmidt

Department of Physical Medicine and Rehabilitation, Brain Injury Rehabilitation Program, St. Mary'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

Mary L. Dombovy

Department of Physical Medicine and Rehabilitation, Brain Injury Rehabilitation Program, St. Mary'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)
DOI: 10.1177/154596839500900106
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