Catatonia, autism, and ECT

Abstract

We describe the clinical presentation, course, and treatment response of a 14-year-old boy with catatonic stupor. This patient, with a preexisting diagnosis of autism, displayed mutism, akinesia, and an extreme level of rigidity, waxy flexibility, posturing, including the psychological pillow, facial grimacing, and other involuntary movements of his upper extremities. In addition he had symptoms suggestive of a depressive disorder as well as some non-specific psychotic symptoms. Intravenous injection of sodium amytal failed to resolve any motor symptoms, although he showed a good response to the zolpidem test. A course of electroconvulsive therapy (ECT) caused dramatic and sustained relief of catatonic stupor without a change in the symptoms of autism. The presentation of catatonia in autism and the use of ECT in children are discussed, and the available literature reviewed. This is the first description of the use of ECT in the treatment of catatonia coinciding with autism and we confirm its efficacy.

Autism-Like Behavior in BTBR Mice Is Improved by Electroconvulsive Therapy

“…This finding, albeit unexpected, was nevertheless congruent with limited clinical evidence suggesting that electroconvulsive therapy (ECT) may have positive effects in patients with autism [6][7][8][9][10]. We surmised that the Bantiautistic^effects of seizures observed in our experiments might not be serendipitous but rather have true Eunice Hagen and Dana Shprung contributed equally to this work.…”

“…Several studies report on beneficial effects of ECT in patients with autism. Most of these studies are case reports, showing improvement of catatonia and self-injurious behavior [6][7][8][9][10], although beneficial effects on intellectual and adaptive functioning have also been observed [38]. No theoretical basis for the potential therapeutic effect of ECT in autism has been discussed.…”

Autonomic Dysfunction in Catatonia in Autism: Implications of a Vagal Theory

“…Youngsters with catatonia and autism often suffer extreme physical compromise, including inability to move, eat or void, development of dangerous cardiovascular and thermoregulatory instability, as well as onset of repetitive, tic-like, self-injurious behaviors with prominent risk of extreme tissue and organ damage and often find significant symptom relief [12][13][14][15][16][17][18][19][20][21][22][23][24][25][26] by ECT for without altering underlying autistic pathology [14,17,21,[24][25][26]. Milder and less advanced cases have benefitted from the use of lorazepam [23], and social, behavioral, and psychological interventions [22].…”

Catatonia: The Ultimate yet Treatable Motor Reaction to Fear in Autism

“…Many such youngsters suffer extreme physical compromise, including inability to move, eat or void, development of dangerous cardiovascular and thermoregulatory instability as well as onset of repetitive, tic-like, self-injury with risk of further tissue and organ damage [14,16,[45][46][47][48][49][50][51][52][53][54][55][56][57].…”

“…Electroconvulsive therapy (ECT) resolved catatonia in several of these patients with improvement in interpersonal behavior and ability to attend school and social events [16,46,49,53,[56][57]. Other, usually milder, cases have benefitted from the use of lorazepam [55], and social, behavioral, and psychological interventions [54].…”