Catatonia After Deep Brain Stimulation Successfully Treated With Lorazepam and Right Unilateral Electroconvulsive Therapy

Abstract

Objectives The presence of a deep brain stimulator (DBS) in a patient who develops neuropsychiatric symptoms poses unique diagnostic challenges and questions for the treating psychiatrist. Catatonia has been described only once, during DBS implantation, but has not been reported in a successfully implanted DBS patient. Materials/Methods We present a case of a patient with bipolar disorder and renal transplant who developed catatonia after DBS for essential tremor. Results The patient was successfully treated for catatonia with lorazepam and electroconvulsive therapy (ECT) after careful diagnostic workup. ECT has been successfully used with DBS in a handful of cases and certain precautions may help reduce potential risk. Conclusions Catatonia is a rare occurrence after DBS, but when present may be safely treated with standard therapies such as lorazepam and ECT.

Safety and Efficacy of Electroconvulsive Therapy for Depression in the Presence of Deep Brain Stimulation in Obsessive-Compulsive Disorder

“…Deep brain stimulation was turned off and, additionally, voltage was set to 0 as a safeguard against inadvertent DBS reactivation. 5,6 The treatments were well tolerated. Electroconvulsive therapy reduced depressive symptoms from severe to mild (Hamilton Depression Rating Scale 7 [HDRS] = 24 at baseline, 7 at discharge) and reduced OCD symptoms from severe to moderate (Y-BOCS = 26 at baseline, 16 at discharge).…”

“…DBS was implanted in these cases to treat Parkinson's disease (subthalamic nucleus 5,10-12 and ventral intermediate nucleus 13 targets), essential tremor (ventral intermediate nucleus target 6,14 ), depression (subcallosal cingulum target 15 ), and cervical dystonia (globus pallidus target 16 ), respectively. This is the first report of ECT in the presence of DBS for OCD.…”

A Case Report of Intramuscular Lorazepam in Catatonia of a Parkinson's Disease Patient After Deep Brain Stimulation

“…DBS has been found to be effective in managing motor problem for refractory PD (Lukins et al 2014). There had been only few reports regarding catatonia in patient with PD (Poyraz et al 2016) or in patients treated with DBS (Coffey et al 2010, Quinn et al 2014. Treatment responses of BZD in those reports were inconsistent.…”

Differential Diagnosis of Psychiatric Symptoms After Deep Brain Stimulation for Movement Disorders

“…Complications necessitating urgent or emergent evaluation are not uncommon . The presence of a DBS in a patient who develops psychiatric symptoms poses unique diagnostic challenges for the treating practitioner, including limitations on diagnostic testing ; the contributions of premorbid conditions, lesion effects, and stimulation effects ; the decision to retain or remove the DBS ; and the safety of psychiatric treatments such as medications and electroconvulsive therapy (ECT) .…”

“…If MRI is to be used for a DBS patient, only scanners that are equipped with 1.5 Tesla horizontal bores, transmit–receive head coils, average head‐specific absorption rates below 0.1 watts/kg, and dB/dt gradients of 20 Tesla/sec or less are permitted according to manufacturer's warnings . The manufacturer's documentation recommends caution when performing ECT in patients with DBS because of similar concerns for the above; numerous case reports attest to the safety of ECT, both bilateral and unilateral, in patients with DBS, as long as attention is paid to ensuring proper indications for ECT are met, turning off DBS prior to each treatment, setting DBS voltage to zero, making sure ECT electrodes are not placed on DBS hardware, and obtaining pre‐ and post‐ECT series brain scans .…”