Cerebrospinal fluid filtration in a case of schizophrenia related to “subclinical” Borna disease virus encephalitis

  • K. Bechter
  • S. Herzog
  • V. Schreiner
  • K-H. Wollinsky
  • R. Schüttler
Conference paper
Part of the Key Topics in Brain Research book series (KEYTOPICS)


Schizophrenia may represent a clinical syndrome caused by various etiologies and through various pathogenetic pathways. Recent studies suggest viruses to be a more important cause of schizophrenia than previously thought. Borna disease virus (BDV) causes meningoencephalitis or behaviour abnormalities in a broad range of animals, and accumulating data suggest a causal role of BDV for human neuropsychiatric disorders including schizophrenia. However, it is difficult to establish causality in the clinical situation. We addressed this problem by detailed investigations over the long term in a suggestive single case. Furthermore, we hypothesized a therapeutic effect of cerebrospinal fluid fiitration (CSFF) in such case comparable to that in therapy resistant postinfectious Guillain-Barré syndrome (GBS).

A variety of signs and findings in a 28 years old man indicated a subclinical BDV encephalitis being responsible for DSM-IV recent onset schizophrenia, mainly: elevating BDV specific serum ab’, elevated CSF proteins, slow alpha-waves and dysrhythmia in EEG on admission (no gross neurologic abnormalities). Positive schizophrenic symptoms improved under psychopharmaca medication but not the primary negative symptoms. Therefore the patient was treated by CSFF in two filtration series, each over five days. Outcome was monitored by a battery of assessments and tests.

Negative schizophrenic symptoms were rapidly improved under CSFF, in parallel neurological soft signs, performance in attention tests and EEG; this was similar in time pattern as GBS symptoms improve under CSFF. Clinical status and test performance remained on an improved level after CSFF (p < 0.05) and improved further spontaneously over the long-term (8 months inpatient, 11 months outpatient observation) to full remission.

We conclude, that we probably observed the natural course of a mild or ‘subclinical’BDV-encephalitis-related schizophrenia, which could be ameliorated by psychopharmaca and CSFF. Removing yet partially defined toxic factors, similar to that found in GBS, from cerebrospinal fluid may explain clinical improvement under CSFF.‘Subclinical’encephalitis by BDV or other viruses may more frequently underly schizophrenic symptoms than previously detected. Our observation indicates a novel pathogenetic principle in a case of schizophrenia.


Inpatient Treatment Neurological Soft Sign Schizophrenic Symptom Filtration Series Recent Onset Schizophrenia 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


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Copyright information

© Springer-Verlag Wien 1999

Authors and Affiliations

  • K. Bechter
    • 1
  • S. Herzog
    • 2
  • V. Schreiner
    • 1
  • K-H. Wollinsky
    • 3
  • R. Schüttler
    • 1
  1. 1.Department Psychiatry II, and Department of Psychiatry, BezirkskrankenhausUniversity of UlmGünzburgGermany
  2. 2.Institute of VirologyJustus-Liebig-UniversityGießenGermany
  3. 3.Department of Anaesthesiology and Intense Care, Rehabilitation Hospital UlmUniversity of UlmFederal Republic of Germany

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