Systemic Lupus Erythematous Presenting as Catatonia and its Response to Electroconvulie Therapy

Hussain, Arshad; Mir, Tajamul H; Dar, Mansoor Ahmad; Naqashbandi, Javid Iqbal; Hussain, Tajamul; Bashir, Anam; Shah, Majid Shafi; Mushtaq, Raheel; Saleem, Basharat

doi:10.4103/0253-7176.168597

Cited by 7 publications

(7 citation statements)

References 16 publications

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“…Outra modalidade de tratamento para catatonia secundária ao LES é a ECT, utilizada após refratariedade ou melhora incompleta do quadro de catatonia com benzodiazepínicos ou mesmo como primeira linha nos casos de catatonia maligna. Seu mecanismo de ação ainda é motivo de estudo, tendo sido descrito que atua através da melhora da transmissão do GABA e da diminuição do glutamato (Hussain et al, 2015). Em outro estudo, verificou-se que sessões de ECT produzem aumento da sensibilidade e, portanto, da atividade funcional dos neurotransmissores dopamina e 5-Hidroxitriptamina (Green et al, 1977).…”

Section: Discussionunclassified

Catatonia secundária ao lúpus eritematoso sistêmico: Revisão sistemática

Figueiredo

Aquino²,

Figueiredo³

2022

RSD

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Lúpus Eritematoso Sistêmico (LES) é uma doença autoimune que é conhecido por estar associado a manifestações neuropsiquiátricas com uma prevalência de 17 a 75% nos portadores da doença. A catatonia tem sido descrita no espectro clínico das manifestações neuropsiquiátricas (MNP) do LES. O objetivo desse estudo foi caracterizar, por meio de uma revisão sistemática, as manifestações clínicas e a terapêutica da catatonia induzida por Lúpus Eritematoso Sistêmico (LES). Foi realizado uma revisão sistemática de relato e série de casos utilizando os descritores “Systemic Lupus Erythematosus” e “Catatonia”, no período de 1977 a 2021, nas bases de dados Medline©, PubMed©, Lilacs©, Scielo© e EMBASE© publicados em Espanhol, Francês, Inglês e Português. De um total de 50 pacientes analisados nos estudos selecionados, cerca de 54% tinham idade entre 18 e 35 anos, com prevalência total no sexo feminino, 90%. Evidenciou-se que o quadro clínico é bem variado com predominância de mutismo (75%), imobilidade/estupor (55%), rigidez (40%) e flexibilidade cérea (40%). 46% dos pacientes apresentaram alterações do sistema nervoso central detectado através da ressonância magnética de cérebro, tomografia computadorizada de crânio, eletroencefalograma ou punção lombar. Em relação ao tratamento proposto a cada paciente, com descrição de melhora, tem-se o uso de benzodiazepínicos, eletroconvulsoterapia, glicocorticoides e imunossupressores como responsáveis por quase todas as respostas de resolutividade. Conclui-se que os transtornos psiquiátricos não são bem descritos no LES. Este estudo evidencia a importância do diagnóstico e tratamento de transtornos psiquiátricos, especialmente a síndrome catatônica. LES deve, portanto, ser incluído no diagnóstico diferencial de pacientes apresentando a síndrome catatônica.

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Section: Discussionunclassified

Catatonia secundária ao lúpus eritematoso sistêmico: Revisão sistemática

Figueiredo

Aquino²,

Figueiredo³

2022

RSD

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“…Secondly, ECT can be safe and effective option for the treatment of prolonged catatonia caused by SS. SS shares a similar autoimmune pathogenesis with SLE; hence, catatonia with SS could be treated with ECT via similar improvement mechanisms to those observed for SLE [ 2 , 4 , 5 ]. Malur et al suggested that ECT is effective for the treatment of prolonged catatonia with complex medical comorbidities, but may require a higher number of treatment sessions compared with therapy for simple catatonia [ 10 ].…”

Section: Discussionmentioning

confidence: 99%

“…Sjögren's syndrome (SS) is also a chronic autoimmune disorder, which is often associated with psychiatric conditions (e.g., depression and anxiety disorders) [ 3 ]. Although SS shares a similar autoimmune pathogenesis with SLE and several cases of NPSLE with catatonia have been reported [ 2 , 4 , 5 ], there is limited knowledge regarding catatonia with SS. Herein, we report a case of prolonged catatonia comorbid with SS.…”

Section: Introductionmentioning

confidence: 99%

A Case of Prolonged Catatonia Caused by Sjögren’s Syndrome

Inagaki

Kudo²,

Kurimoto

et al. 2020

Case Reports in Immunology

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Sjögren’s syndrome (SS) is a chronic autoimmune disorder, often associated with some neuropsychiatric symptoms as well as systemic lupus erythematosus. Although catatonia is frequently reported in patients with systemic lupus erythematosus, it has been rarely reported in patients with SS. Herein, we present a case of SS with catatonia effectively and safely treated with modified electroconvulsive therapy (ECT). A 58-year-old woman showed prolonged catatonia and depressive mood along with pathologically dried eye and mouth. Based on physical findings and blood tests, she was diagnosed with SS. Because of the presence of pressure sores, we were unable to perform lumbar puncture for the diagnosis of abacterial encephalitis. Alternatively, single-photon emission computed tomography of her brain revealed multifocal hypoperfused areas in the parietotemporal region. Consequently, we performed ECT for the treatment of catatonia comorbid with SS. Following 20 sessions of ECT, the catatonia was improved without obvious adverse effects. One week after the last ECT, elevated levels of interleukin-6 were identified in the cerebral fluid. After receiving steroid pulse therapy, she has not experienced catatonia for more than 5 years. SS can cause catatonia, and ECT is a safe and effective option for the treatment of catatonia with SS.

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“…However, NPSLE, in which patients with SLE present with psychosis, is less common, with a prevalence of up to 11% 54 Tan et al 54 described three patients who presented with psychosis during a lupus relapse, and were treated safely and successfully with ECT after their symptoms did not improve with medical treatment (antipsychotics and immunosuppressants). Hussain et al 55 also described a patient with NPSLE presenting with catatonia that did not respond to benzodiazepines or immunosuppression but showed improvement with ECT. ECT may play an important role in the treatment of neuropsychiatric manifestations of SLE and should always be considered as a treatment option if the patient is resistant to medications 55 .…”

Section: Systemic Lupus Erythematosus (Sle)/neuropsychiatric Sle (Npsle)mentioning

confidence: 99%

“…Hussain et al 55 also described a patient with NPSLE presenting with catatonia that did not respond to benzodiazepines or immunosuppression but showed improvement with ECT. ECT may play an important role in the treatment of neuropsychiatric manifestations of SLE and should always be considered as a treatment option if the patient is resistant to medications 55 .…”

Section: Systemic Lupus Erythematosus (Sle)/neuropsychiatric Sle (Npsle)mentioning

confidence: 99%

Anesthesia Management of Special Patient Populations Undergoing Electroconvulsive Therapy: A Review

Wajima

2019

J Nippon Med Sch

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Electroconvulsive therapy (ECT) is the safe application of electricity to the scalp of a patient, using brief-pulse stimulation techniques under general anesthesia and muscle paralysis, inducing a series of generalized epileptic seizures. Principal indications for ECT are major depression (unipolar or bipolar) with a lack of response to medications, intolerance to medications due to side effects or coexisting conditions, the need for a rapid response because of other conditions such as catatonia, psychosis, suicidality, or clinically significant dehydration or malnutrition, mania, and schizophreniform disorder or schizoaffective disorder, and, medical disorders such as Parkinson's disease, neuroleptic malignant syndrome, and chronic pain. Anesthesia management of special patient populations undergoing ECT has been described in textbooks and guidelines, but some descriptions may be antiquated. Therefore, this review describes recent knowledge on anesthesia management of patients who require ECT, such as those with neurologic disorders, cardiovascular disorders, pregnancy, and other concurrent medical illness. Based on the findings of a recent paper, ECT may be safer than is widely reported. According to the American Psychiatric Association, ECT has no absolute contraindications; however, some conditions pose a relatively high risk, and there are many other kinds of complications associated with ECT that can lead to death. Understanding such complications and their management strategies can avoid unnecessary discontinuation of treatment due to manageable complications of ECT and, furthermore, ECT clinicians must also consider the risk-benefit ratio when treating high-risk patients.

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Systemic Lupus Erythematous Presenting as Catatonia and its Response to Electroconvulie Therapy

Cited by 7 publications

References 16 publications

Catatonia secundária ao lúpus eritematoso sistêmico: Revisão sistemática

Catatonia secundária ao lúpus eritematoso sistêmico: Revisão sistemática

A Case of Prolonged Catatonia Caused by Sjögren’s Syndrome

Anesthesia Management of Special Patient Populations Undergoing Electroconvulsive Therapy: A Review

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