title: Catatonia after cerebral hypoxia: do the usual treatments apply?
abstract: BACKGROUND
  Neurologic deterioration occurring days to weeks after a cerebral hypoxic event accompanied by diffuse white matter demyelination is called delayed posthypoxic leukoencephalopathy (DPHL). Manifestations of DPHL are diverse and include dementia, gait disturbance, incontinence, pyramidal tract signs, parkinsonism, chorea, mood and thought disorders, akinetic mutism, and rarely catatonia.
  
  
  METHODS
  We report a case of malignant catatonia in a patient diagnosed with DPHL that was refractory to electroconvulsive therapy (ECT) and review the literature on catatonia in DPHL.
  
  
  RESULTS
  The patient was a 56-year-old woman with schizoaffective disorder who was admitted with catatonia 2 weeks after hospitalization for drug overdose and respiratory failure. Her catatonic symptoms did not respond to treatment of lorazepam, amantadine, methylphenidate, or 10 sessions of bilateral ECT at maximum energy. Repeat magnetic resonance imaging revealed extensive periventricular white matter lesions not present on admission scans, and she was diagnosed with DPHL.
  
  
  CONCLUSIONS
  No treatment for DPHL has been proven to be widely effective. Hyperbaric oxygen treatments may reduce the rate of development, and symptom improvement has been reported with stimulants and other psychotropic agents. Review of literature reveals rare success with GABAergic agents for catatonia after cerebral hypoxia and no cases successfully treated with ECT. There are 7 case reports of neurologic decompensation during ECT treatment after a cerebral hypoxic event.
  
  
  CONCLUSIONS
  Caution is advised when considering ECT for catatonia when delayed sequelae of cerebral hypoxia are on the differential diagnosis, as there is a dearth of evidence to support this treatment approach.
authors.affiliation: Department of Psychiatry, University of New Mexico School of Medicine, Albuquerque, NM.. Electronic address: dquinn@salud.unm.edu.
authors.forename: Davin K
authors.initials: DK
authors.lastname: Quinn
authors.affiliation: Department of Psychiatry, University of New Mexico School of Medicine, Albuquerque, NM.
authors.forename: Christopher C
authors.initials: CC
authors.lastname: Abbott
mesh_terms: D000547:Amantadine / Q000627:therapeutic use; D001921:Brain / Q000473:pathology; D002389:Catatonia / Q000188:drug therapy / Q000209:etiology* / Q000473:pathology / Q000628:therapy; D000697:Central Nervous System Stimulants / Q000627:therapeutic use; D004565:Electroconvulsive Therapy; D005260:Female; D006801:Humans; D002534:Hypoxia, Brain / Q000150:complications*; D056784:Leukoencephalopathies / Q000188:drug therapy / Q000209:etiology / Q000473:pathology / Q000628:therapy; D008140:Lorazepam / Q000627:therapeutic use; D008279:Magnetic Resonance Imaging; D008774:Methylphenidate / Q000627:therapeutic use; D008875:Middle Aged; D059906:Neuroimaging; D017211:Treatment Failure
chemical_list: D000697:Central Nervous System Stimulants; D008774:Methylphenidate; D000547:Amantadine; D008140:Lorazepam