Abstract Objective Report on the first known successful use of ECT for treatment of catatonia in a patient with hypoxic-ischemic brain injury. Background Catatonia is a psychomotor disorder characterized by difficulty initiating or inhibiting volitional behavior. Catatonia is likely underdiagnosed in medically ill patients, whose features may be misinterpreted as delirium or static brain injury-related deficits. While catatonia itself is rarely described after hypoxic-ischemic brain injury, its features are commonly reported in the context of delayed post-hypoxic leukoencephalopathy. To date, there are no reports of successful use of ECT for catatonia in this population. Methods Case Report. 32-year-old man with opioid and cocaine use disorders suffered hypoxic-ischemic brain injury after heroin overdose. He recovered well though reported depressive symptoms. Seven months later, he developed progressive mutism, rigidity, stupor, catalepsy, and dysautonomia consistent with catatonia, unspecified. MRI at that time did not show leukoencephalopathy. Results Twenty-four months after initial injury, lorazepam trial for suspected catatonia produced dramatic improvement but he required increasing doses to maintain effect. Right unilateral ECT was initiated for benzodiazepine-resistant catatonia and the patient received 12 treatments during an inpatient admission with complete resolution of catatonia. He reported no adverse effects. Catatonic symptoms re-emerged after discharge, and he received 21 outpatient ECT treatments (9 right unilateral and 12 bilateral) with overall improvement in catatonia. Conclusions The following factors may underlie the successful use of ECT for treatment of catatonia in this patient with hypoxic-ischemic brain injury: mood symptoms prior to onset of catatonia; initial response to lorazepam; absence of neuroimaging evidence of leukoencephalopathy; and longer length of time between the hypoxic-ischemic brain injury and initiation of ECT. Despite literature suggesting ECT can be detrimental after hypoxic-ischemic brain injury, stringent case selection criteria may allow for safe and effective use of ECT for catatonia in these patients.

中文翻译：

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ECT 治疗缺氧缺血性脑损伤后紧张症的成功应用

摘要 目的 报告首次成功使用 ECT 治疗缺氧缺血性脑损伤患者的紧张症。背景紧张症是一种精神运动障碍，其特征是难以启动或抑制意志行为。内科病人的紧张症很可能未被诊断出来，他们的特征可能被误解为谵妄或静态脑损伤相关的缺陷。虽然在缺氧缺血性脑损伤后很少描述紧张症本身，但其特征通常在迟发性缺氧后白质脑病的背景下被报道。迄今为止，尚无成功使用 ECT 治疗该人群紧张症的报告。方法案例报告。患有阿片类药物和可卡因使用障碍的 32 岁男子在过量服用海洛因后遭受缺氧缺血性脑损伤。尽管他报告了抑郁症状，但他恢复得很好。七个月后，他出现进行性缄默、僵硬、木僵、僵住症和与紧张症一致的自主神经功能障碍，不明。当时的MRI未显示白质脑病。结果 初始损伤后 24 个月，劳拉西泮对疑似紧张症的试验产生了显着改善，但他需要增加剂量以保持效果。右侧单侧 ECT 因苯二氮卓类抗性紧张症开始，患者在住院期间接受了 12 次治疗，紧张症完全缓解。他报告没有不良反应。出院后紧张症状再次出现，他接受了 21 次门诊 ECT 治疗（9 次右侧单侧和 12 次双侧），紧张状态总体改善。结论 下列因素可能是成功使用 ECT 治疗该例缺氧缺血性脑损伤患者紧张症的基础：紧张症发作前的情绪症状；对劳拉西泮的初步反应；缺乏白质脑病的神经影像学证据；缺氧缺血性脑损伤和 ECT 开始之间的时间更长。尽管文献表明 ECT 在缺氧缺血性脑损伤后可能有害，但严格的病例选择标准可能允许安全有效地使用 ECT 治疗这些患者的紧张症。缺氧缺血性脑损伤和 ECT 开始之间的时间更长。尽管文献表明 ECT 在缺氧缺血性脑损伤后可能有害，但严格的病例选择标准可能允许安全有效地使用 ECT 治疗这些患者的紧张症。缺氧缺血性脑损伤和 ECT 开始之间的时间更长。尽管文献表明 ECT 在缺氧缺血性脑损伤后可能有害，但严格的病例选择标准可能允许安全有效地使用 ECT 治疗这些患者的紧张症。