Intermittent catatonia and complex automatisms caused by frontal lobe epilepsy in dementia

Abstract

An 82-year-old man was admitted to the emergency department following bizarre behaviour. Police had noticed him driving erratically through his village. He did not stop when instructed, drove slowly home and appeared 'vacant' on questioning. While in hospital, he had approximately 15 episodes of catatonia, involving rigidity, negativism, mutism except echolalia and perseveration, automatic obedience and utilisation phenomena, lasting 2-20 min each. Between episodes, he was amnestic but otherwise well. Electroencephalography demonstrated bifrontal slowing with left-sided emphasis, and captured two focal onset partial seizures with the clinical correlate of the syndrome described above. He improved rapidly on levetiracetam and lorazepam, was discharged and received a diagnosis of dementia by his community mental health team shortly afterwards, based on chronic short-term memory loss, functional decline and MRI changes. This case has implications for our understanding of the neural correlate of catatonia, specifically frontal lobe pathway dysfunction.

Catatonia in older adults: A systematic review

“…Epilepsy: In this review, 12 older patients with catatonia in the context of epileptic activity were found. Most had nonconvulsive status epilepticus (NCSE)[ 61 , 64 , 65 ], one case had complex partial seizures secondary to viral encephalitis in a patient with BD[ 61 ], one case of frontal lobe epilepsy in a patient with dementia[ 66 ], and a patient with schizophrenia who developed clonic seizures[ 64 ]. Among NCSE patients, 4 cases were associated with the use of antidepressants (bupropion 75 mg/d[ 64 ], paroxetine 20 mg/d[ 67 ], sertraline 50 mg/d[ 67 ], mirtazapine 30 mg/d and sertraline 50 mg/d[ 67 ]) and 1 with paroxetine 7.5 mg/d and gabapentine 900 mg/d withdrawal[ 64 ].…”