Reduced activation and altered laterality in two neuroleptic-naive catatonic patients during a motor task in functional MRI

Background. Catatonia, a symptom complex with motor, affective and cognitiv e symptoms seen in a variety of psychotic conditions and with organic disea se, was examined using a motor task using functional magnetic resonance ima ging (fMRI). Methods. Two acute catatonic patients and two age- and sex-matched healthy controls performed sequential finger opposition (SFO) after being medicated with 2 mg of lorazepam (i.v.). Functional magnetic resonance images were c ollected using a gradient echo pulse sequence (EPI). Results. Patients with catatonia showed reduced motor activation of the con tralateral motor cortex during SFO of the right hand, ipsilateral activatio n was similar for patients and controls. There were no differences in the a ctivation of the SMA. During left hand activation the right-handed catatoni c patients showed more activation in the ipsilateral cortex, a reversal fro m the normal pattern of activation in which the contralateral side shows fo ur to five times more activation than the ipsilateral side. Conclusions. In catatonic patients there is a decreased activation in motor cortex during a motor task compared to matched medicated healthy controls. In addition activation of the non-dominant side, left-handed activity in r ight-handed patients, results in a total reversal of the normal pattern of lateral activation suggesting a disturbance in hemispheric localization of activity during a catatonic state.