Malignant Catatonia

Von Economo’s disease and postencephalitic parkinsonism responsive to carbidopa and levodopa

“…Catatonia is marked by heterogeneous signs that are observed or elicited; most common are immobility, stupor, negativism, staring, and echolalia. 5 , 6 The subtypes are based on the specific nature of movement disturbance and other associated features: retarded – mutism, inhibited movement, posturing, rigidity, negativism, and starting; malignant – fever, autonomic instability, delirium, and rigidity; excited – excessive and purposeless motor activity, restlessness, stereotypy, impulsivity, frenzy, agitation, and combativeness. 5 Benzodiazepines and then electroconvulsive therapy (ECT) are considered as the first line treatment of choice in suspected catatonia.…”

“… 5 , 6 The subtypes are based on the specific nature of movement disturbance and other associated features: retarded – mutism, inhibited movement, posturing, rigidity, negativism, and starting; malignant – fever, autonomic instability, delirium, and rigidity; excited – excessive and purposeless motor activity, restlessness, stereotypy, impulsivity, frenzy, agitation, and combativeness. 5 Benzodiazepines and then electroconvulsive therapy (ECT) are considered as the first line treatment of choice in suspected catatonia. 6 In cases with poor response, there have been reports describing other treatments such as valproate, 7 zolpidem, 8 memantine, 9 and bromocriptine.…”

“…This brought into question of resolving any underlying illness or alternate etiologies, especially, since 60%–80% of reported catatonia cases respond to full remission with benzodiazepine or ECT. 5 Although ECT was considered by the psychiatry team, the patient’s presentation of distal extremity tremors, axial dystonia, dysphagia, decreased spontaneous eye blink rate, and speech impairment suggested highly atypical and unreported symptoms of catatonia, which warranted revisiting the differential diagnoses. A literature search of valproic acid-induced parkinsonism will yield multiple case reports, series, and reviews indicating a likely adverse effect.…”

Comparison of International Therapy Guidelines with Regard to the Treatment of Malignant Catatonia

“…Cases of MC are also described in association with neurological disorders such as cerebrovascular disorders and CNS tumors, encephalitis, metabolic disorders (e. g., hyperthyroidism or Addison's disease), as well as toxic disorders. These include the neuroleptic malignant syndrome (NMS), which can be regarded as a neuroleptic-induced variant of MC [7]. Common clinical signs of MC are shown in ▶ table 2.…”

“…Rigidity may be in part the result of decreased nigrostriatal dopaminergic facilitation of γ-aminobutyric acid neurons activity. Involvement of norepinephrine and serotonin pathways in development of MC has also been discussed [3,7], as well as glutamatergic hyperfunction in general catatonia [13].…”