Efficacy of Transcranial Direct-Current Stimulation in Catatonia: A Review and Case Series

Abstract

Catatonia is a severe neuropsychiatric syndrome, usually treated by benzodiazepines and electroconvulsive therapy. However, therapeutic alternatives are limited, which is particularly critical in situations of treatment resistance or when electroconvulsive therapy is not available. Transcranial direct-current stimulation (tDCS) is a promising non-invasive neuromodulatory technique that has shown efficacy in other psychiatric conditions. We present the largest case series of tDCS use in catatonia, consisting of eight patients in whom tDCS targeting the left dorsolateral prefrontal cortex and temporoparietal junction was employed. We used a General Linear Mixed Model to isolate the effect of tDCS from other confounding factors such as time (spontaneous evolution) or co-prescriptions. The results indicate that tDCS, in addition to symptomatic pharmacotherapies such as lorazepam, seems to effectively reduce catatonic symptoms. These results corroborate a synthesis of five previous case reports of catatonia treated by tDCS in the literature. However, the specific efficacy of tDCS in catatonia remains to be demonstrated in a randomized controlled trial. The development of therapeutic alternatives in catatonia is of paramount importance.

Non-invasive brain stimulation for treating catatonia: a systematic review

“…All six tDCS case reports showed a low risk of bias, and the overall scores were as follows: 100% for one study ( 66 ), 87.5% for three studies ( 63 – 65 ), and 75% for two studies ( 61 , 62 ). The tDCS case series conducted by Haroche et al ( 67 ) showed a moderate risk of bias; in this case series, the criteria for inclusion and demographic information were not clearly described, and it was unclear whether patients were consecutively and completely included.…”

“…Except for one study that reported insufficient improvement in catatonic symptoms, tDCS had a symptom reduction rate ranging from 29 to 100%. Most studies did not report adverse effects; one case reported mild side effects (mostly tingling and itching) ( 66 ), and another case series study consisting of eight patients reported only a burning sensation or tingling ( 67 ).…”

“…Of the remaining eight reports, Weidinger ( 60 ) and Keeser et al ( 61 ) described the same patient and reported results after approximately 66 sessions and 330 sessions of tDCS, respectively; therefore, we included only the latter. Hence, a total of seven studies were included in our systematic review ( 61 – 67 ) (see Figure 1 ).…”

How to manage catatonia, Parkinson and dementia in ICU

“…In less severe forms of catatonia, amantadine, a glutamate antagonists, is now considered as a second line therapy when benzodiazepine have been unsuccessful and ECT is not available [14]. Among the treatments being investigated for catatonia, brain stimulation techniques, in particular noninvasive neuromodulation with transcranial direct-current stimulation (tDCS) targeting the left dorsolateral prefrontal cortex and temporo-parietal junction, have shown rapid efficacy in two recent case series [15 ▪▪ ,16 ▪ ]. At a later stage, first-generation antipsychotics should be avoided and, if necessary, second-generation antipsychotics with a weaker D2 antagonist effect (e.g.…”

Evidence-based consensus guidelines for the management of catatonia: Recommendations from the British Association for Psychopharmacology

“…A single case report observed dramatic resolution of malignant catatonia with rTMS (Kate et al, 2011). Although one case report noted rapid improvement in malignant catatonia with tDCS (Haroche et al, 2022), a second found no effect (Baldinger-Melich, 2016). Like non-malignant catatonia, rTMS and tDCS could prove promising in malignant catatonia where ECT is indicated but not possible.…”