Persistent catatonia following epileptic seizures: a case report and systematic literature search

Abstract

BackgroundCatatonia is frequently associated with mood and psychotic disorders as well as with general medical conditions, especially with seizures. In the case of the latter, catatonia mostly resolves when the seizures respond to the anticonvulsive treatment. We report, to our knowledge, the first case of a patient without affective or psychotic disorder, who developed catatonia in the postictum and whose catatonia did not resolve with anticonvulsive treatment, but did so with lorazepam.Case presentationWe describe a 36-year-old man, with no psychiatric history, except for a possible disorder in the use of cannabis, who developed catatonia after epileptic seizures. The catatonia did not respond to the anticonvulsant therapy, but did so to lorazepam 17 mg/d. Lorazepam could be tapered slowly and stopped without reemergence of catatonic signs.ConclusionCatatonia should be part of the differential diagnosis in patients with bradyphrenia and/or remarkable postictal behavior. This report shows that lorazepam should be taken into consideration (before moving to ECT), in cases of unresolved catatonia, even if the seizures are reduced with anticonvulsants.

Benzodiazepine Withdrawal Catatonia, Delirium, and Seizures in a Patient With Schizoaffective Disorder

“…In some reports of concurrent catatonia and seizures, catatonia was considered as a seizure semiology itself (ictal catatonia), 47 - 50 but in other reports, catatonia and seizures were viewed as distinct phenomena. 51 - 56 Our patient was clearly predisposed to recurrent catatonia on account of schizoaffective disorder. A positive history of head injury also suggested that he was developing a predisposition for seizures (epilepsy).…”

Uso De Lorazepam Em Quadro De Catatonia: Relato De Caso

“…Kahlbaum descreveram pela primeira vez a catatonia como um conjunto de sintomas psicomotores em sua publicação intitulada "Die Katatonie oder das Spannungsirresein". Nessa obra, a principal característica atribuída à catatonia foi um estado de extrema tensão (VERBRAEKEN;LUYKX, 2018).…”

“…Por fim, o quarto tipo é a catatonia periódica, caracterizada pelo retorno cíclico dos sintomas de catatonia. Esses episódios duram em média de quatro a dez dias e podem recorrer semanas ou anos depois (VERBRAEKEN;LUYKX, 2018).…”

“…O diagnóstico diferencial pode ser desafiador devido à falta atual de biomarcadores e à especificidade dos sintomas. Diversas condições precisam ser consideradas no diagnóstico diferencial, tais como síndrome antipsicótica maligna, efeitos colaterais extrapiramidais de medicamentos psicofarmacológicos, encefalopatia hiperamonêmica, distonia aguda, discinesia tardia, acatisia, episódios maníacos, delirium, distúrbios do movimento compulsório, distúrbio de conversão, certas compulsões no TOC, síndrome da serotonina, síndrome do encarceramento, estado vegetativo e Síndrome da Pessoa Rígida, distúrbios cinéticos com hipocalcemia, tétano, toxicidade por estricnina, raiva e complexos de epilepsia parcial, estado de mal epiléptico não convulsivo (VERBRAEKEN;LUYKX, 2018).…”

Konrád Jenő adta a catatonia első magyar nyelvű, tudományos igényű leírását 1881/82-ben

“…Két páciensnek dystoniás, egynek komplex parciális rohama, egynek pedig absence status epilepticusa volt. Egy esetleírásban epilepsziás rohamot követően kialakult, perzisztáló cataton állapotról számoltak be, amely antiepileptikumra nem, csak lorazepámra reagált [17].…”