Electroconvulsive therapy as a treatment for refractory neuropsychiatric lupus with catatonia: three case studies and literature review

Abstract

Neuropsychiatric disorders associated with systemic lupus erythematosus are very common. Treatment generally consists of glucocorticoids and immunosuppressive therapy; however, some cases are unresponsive. Electroconvulsive therapy (ECT) is a recognized treatment modality in psychiatry and is an option for refractory cases of neuropsychiatric lupus. This report describes three cases of neuropsychiatric lupus that improved with ECT after failure of antipsychotics and immunosuppressive therapy. All cases met DSM-5 criteria for catatonia (case 1: agitation, stereotypies, and grimacing; case 2: stupor, mutism, and grimacing; case 3: agitation, mutism, and stereotypies); therefore, ECT was indicated. This case series shows that ECT can be a therapeutic option in patients with neuropsychiatric lupus, especially when associated with catatonia and unresponsive to conventional treatment.

Electroconvulsive Therapy as a Potential Trigger of Adult Onset Still’s Disease

“…Until now, there is no published association between ECT and autoimmune disorders. ECT has been successfully used for the treatment of neuropsychiatric lupus erythematosus and autoimmune encephalitis but literature is limited to case reports and focuses on the psychiatric outcome [16,17]. The role of the immunomodulatory effects of ECT in these inflammatory disorders remains unclear.…”

Deutsche Gesellschaft für Psychiatrie und Psychotherapie, Psychosomatik und Nervenheilkunde e. V.

“…Evidenzlücken füllen, um Patienten eine potenziell hochwirksame und bisweilen lebensrettende Therapie nicht vorzuenthalten. Katatone Syndrome (inklusive perniziöse Katatonie und malignes neuroleptisches Syndrom) S3-Leitlinie Schizophrenie [3, [13][14][15][16] Organisch/neuropsychiatrisch bedingte Syndrome wie oben genannt [17][18][19][20][21] Therapieresistente schwere Verhaltensstörungen (z. B. schwere (Auto-)Aggression) i. R. neuropsychiatrischer Störungen, Demenzen, Autismus-Spektrum-Störungen und anderer intellektueller Entwicklungsstörungen [22][23][24][25][26][27] Autoimmunenzephalitis (mit therapieresistenten, schweren psychiatrischen Symptomen) [28] Therapierefraktäres Parkinson-Syndrom (motorische und psychiatrische Symptome) [17] Therapierefraktärer Status epilepticus [29,30] Therapieresistente delirante Syndrome (inkl.…”