The use of electroconvulsive therapy in a patient with juvenile systemic lupus erythematosus and catatonia

Abstract

Catatonia is a rare manifestation in patients with systemic lupus erythematosus (SLE). As catatonia can be associated with both psychiatric and organic conditions, this could create a diagnostic dilemma once this occurs in SLE patients. The report describes a 15-year-old female with SLE who developed catatonia three days after the diagnosis of SLE was made. Her catatonia was refractory to the treatment with immunosuppressive therapy, which included pulse methylprednisolone, intravenous cyclophosphamide, rituximab, intravenous immunoglobulin (IVIG) and plasmapheresis. Given her persistent catatonia, electroconvulsive therapy (ECT) was initiated three months after the onset of her symptoms. After the third ECT treatment, her mental status dramatically improved and returned nearly to baseline while she was continued on the immunosuppression. This is the first report of a successful ECT therapy in catatonic lupus in children.

A Clinical Review of the Treatment of Catatonia

“…A number of cases are illustrative of the overall good prognosis, even in chronic and longstanding catatonic symptoms. A man with a 17-year history of catatonia responded swiftly to the administration of lorazepam ( 35 ); a 15-year-old girl with catatonic lupus, resistant to several treatments was successfully treated with ECT after 3 months ( 36 ). A man developing catatonia after myocardial infarction remained catatonic for 1.5 years until he was treated with ECT ( 37 ).…”

“…Recently, several authors report on the successful use of unilateral ECT in a total number of 21 cases ( 36 , 144 ), 15 of which were treated with an ultra-brief pulse (UB) width ( 139 , 145 , 146 ). In a case-series of 5 patients with catatonia, resistant to benzodiazepines, 4 patients experienced a full response with unilateral ECT; one patient achieved only partial response, and was switched to bitemporal without experiencing any additional benefit ( 144 ).…”

SLE presenting with catatonia in an adolescent girl

“…Of these 23 cases of catatonia in SLE, only eight cases[789101112131415] have been reported in patients younger than 18 years of age with youngest patient being aged 13 years. Our case adds to this limited data and suggests that although rare, catatonia can be seen in patients of SLE.…”

“…[11] In the index case, symptoms of SLE developed prior to psychiatric manifestations and catatonia developed in the natural course of illness of SLE possibly due to the disease progression.…”

Catatonia due to systemic lupus erythematosus

“…Although catatonia as an expression of a pure mental disorder is a diagnosis of exclusion 3 and it has usually a recognizable organic component 4 , when placing it into an organic mental syndrome, psychiatrist evaluation is valuable since the clinical manifestations are mainly mental and behavioral 5 . Often, there is an association with previous psychiatric conditions 6 and need of treatment with benzodiazepines or eletroconvulsive therapy in refratary cases [7][8][9] . Catatonia has been rarely reported as an SLENP manifestation in pediatric patients 9,10 .…”