title: Impairment of the cortical GABAergic inhibitory system in catatonic stupor: a case report with neuroimaging.
abstract: We report the case of a 32-year-old patient who presented with catatonic stupor during the course of acute aseptic encephalitis involving the right frontotemporal area. Flumazenil-PET performed during the stupor indicated decreased benzodiazepine receptor binding in the right frontotemporal area where glucose metabolism was preserved as revealed by FDG-PET. An injection of diazepam immediately ameliorated catatonic symptoms and reduced widespread high amplitude slow EEG activities with right frontotemporal predominance. Compared with a SPECT study performed a week earlier, there was no abnormal right-sided anteriorly predominant cerebral hyperperfusion after injection of diazepam. While neither flumazenil- nor FDG-PET could be repeated, and with the caveat that generalized convulsions occurred initially and epilepsia partialis continua was present for two weeks starting on the 23rd day after illness onset, these findings suggest that in our case the presentation with catatonic stupor may be related to impairment of the cortical GABAergic inhibitory system.
authors.affiliation: Department of Neurology, Kyoto University Hospital, Kyoto, Japan.
authors.forename: Kazumi
authors.initials: K
authors.lastname: Iseki
authors.forename: Akio
authors.initials: A
authors.lastname: Ikeda
authors.forename: Takeshi
authors.initials: T
authors.lastname: Kihara
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Kawamoto
authors.forename: Takahiro
authors.initials: T
authors.lastname: Mezaki
authors.forename: Takashi
authors.initials: T
authors.lastname: Hanakawa
authors.forename: Kazuo
authors.initials: K
authors.lastname: Hashikawa
authors.forename: Hidenao
authors.initials: H
authors.lastname: Fukuyama
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Shibasaki
mesh_terms: D000208:Acute Disease; D000328:Adult; D002389:Catatonia / Q000188:drug therapy* / Q000209:etiology / Q000378:metabolism*; D002540:Cerebral Cortex / Q000378:metabolism* / Q000503:physiopathology*; D003975:Diazepam / Q000008:administration & dosage / Q000494:pharmacology*; D004569:Electroencephalography; D004660:Encephalitis / Q000150:complications; D005442:Flumazenil / Q000378:metabolism; D019788:Fluorodeoxyglucose F18; D005625:Frontal Lobe / Q000378:metabolism / Q000503:physiopathology; D007839:Functional Laterality; D018757:GABA Modulators / Q000008:administration & dosage / Q000494:pharmacology*; D005947:Glucose / Q000378:metabolism; D006801:Humans; D008297:Male; D049268:Positron-Emission Tomography; D019275:Radiopharmaceuticals; D053608:Stupor / Q000209:etiology / Q000378:metabolism; D013702:Temporal Lobe / Q000378:metabolism / Q000503:physiopathology; D015899:Tomography, Emission-Computed, Single-Photon
chemical_list: D018757:GABA Modulators; D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18; D005442:Flumazenil; D005947:Glucose; D003975:Diazepam