As initial intravenous treatment for overt generalized convulsive status epilepticus, lorazepam is more effective than phenytoin. Although lorazepam is no more efficacious than phenobarbital or diazepam plus phenytoin, it is easier to use.

SUMMARY Three patients with EEG documented ictal catatonia, a nonconvulsive status epilepticus, who responded dramatically to intravenous phenytoin are described. The EEG showed continuous bilateral pseudoperiodic sharp waves and spike discharges in one patient, spike and wave complexes were seen prominently in the right fronto-central region in another, and the EEG of the third patient showed periodic lateralising epileptiform discharges during the catatonic state. We postulate that such catatonia was due to involvement of the limbic system by seizure activity.Kahlbaum' first described a syndrome consisting of catalepsy and waxy flexibility, mutism, muscle rigidity, psychotic negativism, stereotypies and verbigeration. These symptoms are associated with conditions such as schizophrenia, affective disorders, and a variety of metabolic derangements and structural disorders of the brain.2 Adequately documented catatonia with concurrent epileptic discharges on the electroencephalogram (EEG) has been described only rarely.3-5 We report three cases of nonconvulsive status epilepticus, confirmed by EEG, manifested by catatonia which responded to intravenous phenytoin. Case reportsCase I A 55-year-old black male had a long history of chronic psychosis and was treated with thioridazine. He presented to another hospital with four generalised tonic/clonic seizures which were controlled with intravenous diazepam. On examination at the Philadelphia VA Medical Center the patient appeared awake but had a fixed and glassy-eyed stare. His eyes were in the midline. His face was immobile. He did not recognise his environment. Occasionally, upon repeated questioning, the patient would utter his name. Cranial nerve function was intact. Muscle tone was increased with no focal weakness. However, he exhibited waxy flexibility, maintaining the extremities indefinite in any passively placed bizarre posture. The EEG on the day of admission showed continuous bilateral pseudoperiodic sharp waves and spike discharges ( fig IA). Case 3 A 59-year-old male admitted with frequent episodes of confusion for three weeks. During these episodes he was observed to stare blankly with a decrease in verbal output and physical activity. One year prior to the admission he 833 by copyright.

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