Abstract: Transcranial magnetic stimulation (TMS) is used for therapeutic and research purposes, but it is still important to establish safety guidelines and recommendations mainly related to serious adverse effect (SAE). As part of this, safety reports need to be published. Our report highlights a case of a male patient who was a 30-year-old with a history of hemorrhagic stroke following an accidental seizure episode during a single-pulse TMS.
Background: Electroconvulsive therapy (ECT) is highly efficacious in catatonia yet remains underutilized in pediatric patients. Practice guidelines recommend bilateral placement in cases with urgent need for response such as catatonia. Because of significantly lower cognitive burden and efficacy (compared to bilateral), right unilateral placement (RUL) is preferred for major depression. Increasing literature shows RUL is effective for catatonia in adults, but its use in catatonic youth is largely unknown.
Objectives: The aims of the study are to describe naturalistic outcomes of ECT in pediatric patients with catatonia and to discuss ECT parameter considerations.
Methods: This is a retrospective chart review of patients under 18-years of age at Saint Louis Children's Hospital with diagnosis of catatonia who received ECT from 2019 to November 2023. All cases received ECT per clinical protocol. Catatonic symptoms were monitored using the Busch Francis Catatonia Scale. Institutional review board approved the study.
Results: Twelve inpatients with debilitating catatonia and a failed benzodiazepine trial underwent ECT. Ten of these 12 patients initiated RUL placement, one received bifrontal, and another bilateral. All patients achieved resolution of catatonia: 6 patients with RUL alone and 4 who started with RUL later switched to bilateral due to nonresponse. The patient receiving bifrontal switched to bilateral due to nonresponse. Patients with malignant catatonia preferentially responded to bilateral placement. Patients experienced expected side effects from ECT.
Conclusions: RUL ECT was effective for catatonia in pediatric patients and can be considered as initial placement. A switch to bilateral can be considered in nonresponse, similar to current approach for major depression. For malignant catatonia, bilateral placement remains preferential.
Abstract: The SCN2A gene encodes a subunit that forms part of voltage-gated sodium channels in the brain. Gain-of-function mutations are associated with epilepsy as well as numerous movement/motor abnormalities. Loss-of-function mutations may also cause epilepsy in addition to a variety of neurodevelopmental anomalies, including autism and intellectual disability. The occurrence of catatonia has also been described in 1 previous report that involved a 4-year-old boy. We describe a 20-year-old intellectually disabled female patient who developed recurrent catatonic symptoms in her teenage years that remitted with electroconvulsive therapy. This is only the second report of catatonia occurring in relation to an SCN2A mutation and the first involving a female. Moreover, this case is unique given our patient's later age of symptom onset and given that her symptoms responded well to electroconvulsive therapy.
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