ECT for prolonged catatonia

Objective and Background: Electroconvulsive therapy (ECT) is highly effecti ve for acute catatonia but its use in prolonged catatonia is not well estab lished. We report three cases of prolonged catatonia with medical complicat ions or comorbidities treated by ECT. Method: Case reports. Results: A 24 y ear-old woman developed fever and autonomic instability after parenteral ne uroleptics. Catatonia and autonomic signs persisted for 14 weeks. After min imal improvement from lorazepam, 15 bilateral ECTs led to resolution. A 26- year-old woman with a history of lupus erythematosus, complicated by lupus cerebritis with lesions in the cortex and basal ganglia and a communicating hydrocephalus, was catatonic for 9 weeks. Lorazepam produced marginal impr ovement. A series of 14 bilateral ECTs led to improved mobility, speech, an d interaction, but the response was less robust than Case 1. A 40-year-old man with mental retardation and intermittent psychosis developed severe neu roleptic malignant syndrome and remained catatonic for 4 months. After lora zepam produced minimal improvement, his catatonia resolved with 20 bilatera l ECTs. Conclusions: ECT may improve prolonged catatonia with complex medic al comorbidities, but may require many treatment sessions. Gross cerebral p athology may predict a less robust response. As for acute catatonia, ECT ma y resolve prolonged catatonia after benzodiazepines have failed.