The use of quetiapine in treatment of acute psychotic symptoms in an adolescent patient with primary brain calcification: a case report

Abstract

BackgroundPrimary brain calcification (PBC), a neurodegenerative disorder with characteristic calcium deposits in the basal ganglia and other brain areas, typically presents with various neurological and psychiatric symptoms in the fourth or fifth decade of life or later. We present the case of a patient with psychiatric manifestations much earlier than usual, in the second decade of life.Case presentationThe case of an adolescent female with acute psychotic symptoms, emotional instability, disorganized and suicidal behavior, stereotypical movements, below average intelligence and a three-year history of headaches is reported. Among others, the presentation included tactile hallucinations with secondary hypochondriacal delusions, which are rarely described in this diagnosis. Massive calcinations in the area of the basal ganglia and thalamus were determined by computerized tomography. Other causes of brain calcification were excluded. No causative mutations were found in selected genes. All the symptoms apart from lower intellectual abilities improved with quetiapine and sertraline. The patient showed no side effects.ConclusionsThis case report highlights the successful use of quetiapine for symptomatic treatment of acute psychosis due to PBC in an adolescent without exacerbating extrapyramidal symptoms.

SLC20A2-Associated Idiopathic Basal Ganglia Calcification-Related Recurrent Psychosis Response to Low-Dose Antipsychotics: A Case Report and Literature Review

“…A review reported mood disorders in IBGC had complex syndromes [ 11 ]; however, psychosis in IBGC is underrecognized and limited to some case reports (Table 1 ). Most of the reported cases have a short observational period and are complicated with cognitive impairment or movement disorders [ 12 - 18 ]. Only a few cases [ 19 ], including ours, have reported psychiatric symptoms alone.…”

The Pathology of Primary Familial Brain Calcification: Implications for Treatment

“…reported an adolescent patient for whom quetiapine treatment successfully attenuated acute psychosis, and Uno et al . reported a middle-aged patient who was relieved of recurrent psychosis with risperidone) and no positive effect on brain calcification has been shown; moreover, the risk of symptom relapse is high [ 26 , 157 ].…”