Use of ECT for Children With and Without Catatonia

Abstract

Objectives The objective study was to investigate the safety and efficacy of electroconvulsive therapy (ECT) in a retrospective cohort of pediatric patients. Methods A single-site retrospective analysis was conducted of patients aged younger than 18 years who received ECT in a private university hospital from January 28, 2012 to April 8, 2023. Treatment efficacy and adverse events were determined retrospectively through review of the medical record. Results A total of 36 pediatric patients met the inclusion criteria. Catatonia was the most common presenting indication for ECT, followed by psychosis and suicidal ideation. For all patients, Clinical Global Impressions–Improvement scale scores indicated that it was very likely for a subject to experience at least “much improvement” with the estimated probability of receiving a Clinical Global Impressions–Improvement scale score better than 3 of 0.852 (t.s. = 16.3; P < 0.001; 95% confidence interval, 0.711–0.931). All patients with catatonia demonstrated a positive clinical response and experienced a statistically significant reduction in total Bush-Francis Catatonia Rating Scale scores observed (t = 11.9; df = 20; SD = 6.3; P < 0.001; 95% confidence interval, 12.6–17.9). No significant adverse events were reported for any patient in the cohort. However, 14 (38.9%) patients experienced prolonged seizures, all of which were terminated with propofol (mean, 49.7 mg). Conclusions This study provides further data supporting the safe and effective use of pediatric ECT in the treatment of various psychiatric conditions. However, more research is needed to determine the risk factors associated with prolonged seizures and the optimal seizure parameters in young people.

Exploring the Trajectory of Catatonia in Neurodiverse and Neurotypical Pediatric Hospitalizations: A Multicenter Longitudinal Analysis

“…In this cohort, 14.5% of pediatric catatonia patients required treatment with ECT. This procedure has established efficacy in neurodiverse and neurotypical patients with catatonia, including those refractory to medication treatment, 6 , 30 , 31 but remains legally restricted in many US states 32 and with sociodemographic disparities in access. 33 , 34 Barriers to access to ECT in youth have been associated with substantial harm, 35 , 36 and results from this cohort point strongly to the critical need for ECT access in young patients with catatonia.…”

“… 5 If correctly identified, however, pediatric catatonia often responds rapidly to treatment. 6 , 7 Thus, the identification and treatment of pediatric catatonia in the inpatient pediatric medical setting presents a unique opportunity for prompt and significant intervention which may drastically improve a child’s course of illness. 8 – 10 …”

“…5 If correctly identified, however, pediatric catatonia often responds rapidly to treatment. 6,7 Thus, the identification and treatment of pediatric catatonia in the inpatient pediatric medical setting presents a unique opportunity for prompt and significant intervention which may drastically improve a child's course of illness. [8][9][10] Along with medically ill children, neurotypical children with psychiatric disorders and neurodiverse children are at significantly elevated risk of catatonia.…”