To evaluate safety and utility of electroconvulsive therapy (ECT) in patients with NMDARE through a systematic literature review and a retrospective, multi-center cohort. 

Neuropsychiatric symptoms in NMDARE are often severe and difficult to treat, leading some to pursue empiric trials of ECT, despite unclear safety and efficacy in NMDARE patients.

Systematic review: PubMed and Embase databases were searched to identify 37 articles describing 39 patients with NMDARE undergoing ECT. Retrospective cohort analysis: clinical information from a previously identified cohort of 577 patients with NMDARE was reviewed to identify 21 patients undergoing ECT. 

Systematic review: We identified 39 cases of NMDARE patients receiving ECT during their acute illness. Good clinical improvement was attributed to ECT in 12 cases (31%), partial or equivocal improvement in 7 cases (18%), and no improvement in 3 cases (8%). Worsening of clinical course following ECT was reported in 11 patients (28%). Clinical response following ECT was not described in 6 cases.  

Retrospective cohort: We identified a cohort of 21 cases of NMDARE patients receiving ECT during their acute illness. A good response to ECT was noted in 2 patients (10%), partial or equivocal in 2 patients (10%), no improvement in 5 patients (24%), and worsening of clinical course following ECT was seen in 8 (38%) of patients. Clinical response following ECT was not available for 4 patients. 

We present a systematic review of patients with NMDARE receiving ECT, as well as a multicenter, retrospective cohort of NMDARE patients undergoing ECT. We conclude that there is currently not sufficient data supporting a beneficial effect of ECT in NMDARE. Confounding factors, including concurrent immunotherapy use, make interpretation of available cases challenging. In patients with worsening clinical courses following ECT, immunotherapies had not been given, underscoring the essential need to prioritize diagnosis and treatment of the underlying disease.