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Catatonia with schizophrenia: From ECT to rTMS.
E Stip1, M-E Blain-Juste2, O Farmer3
1CHUM, Notre-Dame, Montréal, QC, Canada; Department of Psychiatry, University of Montréal, h2l 2w5 Montréal, QC, Canada; Neuromodulation unit, CHUM, Montréal, QC, Canada.
L'Encephale
|December 16, 2017
Summary
Repetitive Transcranial Magnetic Stimulation (rTMS) offers a promising alternative for treating catatonic schizophrenia when other methods fail. This neuromodulation technique shows effectiveness in both acute and maintenance phases, especially when electroconvulsive therapy (ECT) poses safety concerns.
Area of Science:
- Neurology
- Psychiatry
- Neuroscience
Background:
- Electroconvulsive therapy (ECT) is a standard treatment for catatonic schizophrenia, particularly after pharmacologic interventions like lorazepam or Zolpidem fail.
- Some patients require ongoing maintenance ECT, while newer neuromodulation techniques such as repetitive Transcranial Magnetic Stimulation (rTMS) and transcranial direct-current stimulation (tDCS) are being explored for catatonia.
Purpose of the Study:
- To explore alternatives to electroconvulsive therapy (ECT) for patients with refractory catatonia.
- To review the efficacy and application of repetitive Transcranial Magnetic Stimulation (rTMS) as a treatment for catatonic schizophrenia.
Main Methods:
- A literature search was conducted on Medline, Google Scholar, PsychInfo, and CAIRNS using keywords such as 'catatonia', 'rTMS', 'ECT', and 'tDCS'.
- The review focused on case reports detailing the use of rTMS and tDCS as alternatives to ECT for catatonia.
- Six case reports on rTMS and three on tDCS were analyzed to discuss treatment strategies and outcomes.
Main Results:
- High-frequency rTMS was identified as a potential alternative to ECT, especially for patients with comorbid epilepsy where chronic ECT poses risks.
- rTMS treatment, administered 3-4 times weekly and later extended to bi-weekly, demonstrated persistent improvement in catatonia symptoms as measured by the Bush-Francis Catatonia Rating Scale.
- While ECT was effective for some, including one patient with 556 sessions over 20 years, rTMS presented a viable option for those with safety concerns regarding long-term ECT.
Conclusions:
- Repetitive Transcranial Magnetic Stimulation (rTMS) is effective for both acute and maintenance treatment of catatonic schizophrenia.
- rTMS should be considered a potential treatment option for refractory catatonia, particularly when pharmacologic interventions have failed and there are safety concerns with continued maintenance ECT.
Keywords:
Brain stimulationCatatoniaCatatonieElectroconvulsivotherapySchizophreniaSchizophrénieStimulation magnétique transcraienneZolpidem(®)rTMS
