Use of ECT in a 14-Year-Old with Treatment-Refractory Catatonia: A Case Report
Location
Center for Advanced Learning and Simulation (CALS)
Publication Date
April 2025
Start Date
17-4-2025 8:00 AM
Description
Catatonia is a syndrome characterized by motor, psychiatric, and behavioral abnormalities caused by myriad neurological, psychiatric, and medical disorders. Common symptoms include rigidity, staring, mutism, posturing, excessive motor activity, stupor, negativism, and echolalia. Benzodiazepines are first-line treatment, however, electroconvulsive therapy (ECT) is used if the catatonia does not resolve with medical treatment. ECT has a 75-85% efficacy rate in pediatric catatonia, however, is not commonly pursued due to ethical concerns, particularly surrounding consent. Here we present a case of treatment-resistant catatonia in a pediatric patient which necessitated the use of ECT. A 14-year-old female patient with no known psychiatric history presented for a 1-week history of not talking, walking, or eating. Initial medical workup including laboratory tests, imaging, and EEG were negative. Subsequent results were notable for a positive anti-DNase B antibody and an elevated anti-streptolysin O titer, consistent with a prior streptococcal infection. An encephalitis panel subsequently resulted negatively, and genomic sequencing was unrevealing. The patient was started on lorazepam and amantadine to treat catatonia and carbamazepine was later trialed. The lab results raised suspicion that pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAS) could have caused the patient's catatonia, therefore she was started on treatment with cefdinir followed by azithromycin and methylprednisolone without significant changes. Intravenous immunoglobulin was administered, which yielded modest, but temporary, improvement. Without notable and long-lasting improvement, higher doses of benzodiazepines were used (lorazepam 4 mg every six hours) and methylphenidate was added. Given the patient's persistent catatonia refractory to medical treatment, ECT was pursued. The patient underwent 22 ECT treatments in total, which resulted in moderate improvements to her condition. At this time, ECT will be on hold and the patient will be observed for regression. Clozapine and zolpidem have been initiated in the meantime and the patient will be monitored for improvement.
Recommended Citation
Nguyen, Tina; Steipler, Zachary; and Conrad, Erich MD, "Use of ECT in a 14-Year-Old with Treatment-Refractory Catatonia: A Case Report" (2025). Dept. of Psychiatry Research Symposium. 3.
https://digitalscholar.lsuhsc.edu/psych_rd/2025/presentations/3
Use of ECT in a 14-Year-Old with Treatment-Refractory Catatonia: A Case Report
Center for Advanced Learning and Simulation (CALS)
Catatonia is a syndrome characterized by motor, psychiatric, and behavioral abnormalities caused by myriad neurological, psychiatric, and medical disorders. Common symptoms include rigidity, staring, mutism, posturing, excessive motor activity, stupor, negativism, and echolalia. Benzodiazepines are first-line treatment, however, electroconvulsive therapy (ECT) is used if the catatonia does not resolve with medical treatment. ECT has a 75-85% efficacy rate in pediatric catatonia, however, is not commonly pursued due to ethical concerns, particularly surrounding consent. Here we present a case of treatment-resistant catatonia in a pediatric patient which necessitated the use of ECT. A 14-year-old female patient with no known psychiatric history presented for a 1-week history of not talking, walking, or eating. Initial medical workup including laboratory tests, imaging, and EEG were negative. Subsequent results were notable for a positive anti-DNase B antibody and an elevated anti-streptolysin O titer, consistent with a prior streptococcal infection. An encephalitis panel subsequently resulted negatively, and genomic sequencing was unrevealing. The patient was started on lorazepam and amantadine to treat catatonia and carbamazepine was later trialed. The lab results raised suspicion that pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAS) could have caused the patient's catatonia, therefore she was started on treatment with cefdinir followed by azithromycin and methylprednisolone without significant changes. Intravenous immunoglobulin was administered, which yielded modest, but temporary, improvement. Without notable and long-lasting improvement, higher doses of benzodiazepines were used (lorazepam 4 mg every six hours) and methylphenidate was added. Given the patient's persistent catatonia refractory to medical treatment, ECT was pursued. The patient underwent 22 ECT treatments in total, which resulted in moderate improvements to her condition. At this time, ECT will be on hold and the patient will be observed for regression. Clozapine and zolpidem have been initiated in the meantime and the patient will be monitored for improvement.