ECT Intervention for Catatonia in a Patient with Epilepsy and Multiple Sclerosis
Location
Center for Advanced Learning and Simulation (CALS)
Publication Date
April 2025
Start Date
17-4-2025 8:00 AM
Description
Introduction: Electroconvulsive therapy (ECT) is widely used for treatment of drug-refractory major depressive disorder, schizophrenia, and bipolar depression (Shin et al., 2023). Psychiatric disorders are a common comorbidity in patients with epilepsy and multiple sclerosis, so it is not uncommon for these patients to be referred for a course of ECT treatments (Lunde et al., 2006). However, there is scant data regarding the safe and effective use of ECT in these patients as there are several challenges to consider: difficulty inducing seizures due to antiepileptic medications, risk of prolonged seizures, and risk of breakthrough seizures (Shin et al., 2023). Several case reports present the application of ECT for treatment of refractory status epilepticus and drugrefractory seizure (Shin et al., 2023). In this case report, we describe successful use of ECT for catatonia secondary to recurrent major depressive disorder in a patient with epilepsy and multiple sclerosis. Case Presentation: A 38-year-old woman with multiple sclerosis, epilepsy, and comorbid depression was admitted for catatonia following over a year. She was without history of suicide attempt, recreational drug use, or inpatient psychiatric admission with previous failed trials of multiple antidepressants. Additionally, previous outpatient and inpatient lorazepam trials for catatonia led to excessive sedation without improvement. ECT was offered due to the severity and longevity of her catatonia and depression. Antiepileptic medications were held on the morning of ECT and resumed post-treatment. Across 13 treatments, five resulted in prolonged seizures (>120 seconds), and of these, two required terminations with midazolam. All treatments utilized muscle relaxant. By the end of her hospital course, catatonia resolved with significant improvement in mood, oral intake, and spontaneous speech. Discussion: ECT is a viable intervention for catatonia in patients with epilepsy and multiple sclerosis, emphasizing the need for individualized seizure management and close monitoring during treatment.
Recommended Citation
Scott, Jonathon MD; Pham, Thien-Huong Michelle MD, MPH; Teachout, Hailey MD; Khan, Kamran; and Knight, Michael MD, "ECT Intervention for Catatonia in a Patient with Epilepsy and Multiple Sclerosis" (2025). Dept. of Psychiatry Research Symposium. 19.
https://digitalscholar.lsuhsc.edu/psych_rd/2025/presentations/19
ECT Intervention for Catatonia in a Patient with Epilepsy and Multiple Sclerosis
Center for Advanced Learning and Simulation (CALS)
Introduction: Electroconvulsive therapy (ECT) is widely used for treatment of drug-refractory major depressive disorder, schizophrenia, and bipolar depression (Shin et al., 2023). Psychiatric disorders are a common comorbidity in patients with epilepsy and multiple sclerosis, so it is not uncommon for these patients to be referred for a course of ECT treatments (Lunde et al., 2006). However, there is scant data regarding the safe and effective use of ECT in these patients as there are several challenges to consider: difficulty inducing seizures due to antiepileptic medications, risk of prolonged seizures, and risk of breakthrough seizures (Shin et al., 2023). Several case reports present the application of ECT for treatment of refractory status epilepticus and drugrefractory seizure (Shin et al., 2023). In this case report, we describe successful use of ECT for catatonia secondary to recurrent major depressive disorder in a patient with epilepsy and multiple sclerosis. Case Presentation: A 38-year-old woman with multiple sclerosis, epilepsy, and comorbid depression was admitted for catatonia following over a year. She was without history of suicide attempt, recreational drug use, or inpatient psychiatric admission with previous failed trials of multiple antidepressants. Additionally, previous outpatient and inpatient lorazepam trials for catatonia led to excessive sedation without improvement. ECT was offered due to the severity and longevity of her catatonia and depression. Antiepileptic medications were held on the morning of ECT and resumed post-treatment. Across 13 treatments, five resulted in prolonged seizures (>120 seconds), and of these, two required terminations with midazolam. All treatments utilized muscle relaxant. By the end of her hospital course, catatonia resolved with significant improvement in mood, oral intake, and spontaneous speech. Discussion: ECT is a viable intervention for catatonia in patients with epilepsy and multiple sclerosis, emphasizing the need for individualized seizure management and close monitoring during treatment.