Use of Electroconvulsive Therapy in Children and Adolescents With Catatonia-A Case Series

Electroconvulsive therapy (ECT) is highly efficacious in catatonia yet remains underutilized in pediatric patients. Practice guidelines recommend bilateral placement in cases with urgent need for response such as catatonia. Because of significantly lower cognitive burden and efficacy (compared to bilateral), right unilateral placement (RUL) is preferred for major depression. Increasing literature shows RUL is effective for catatonia in adults, but its use in catatonic youth is largely unknown.

The aims of the study are to describe naturalistic outcomes of ECT in pediatric patients with catatonia and to discuss ECT parameter considerations.

This is a retrospective chart review of patients under 18-years of age at Saint Louis Children's Hospital with diagnosis of catatonia who received ECT from 2019 to November 2023. All cases received ECT per clinical protocol. Catatonic symptoms were monitored using the Busch Francis Catatonia Scale. Institutional review board approved the study.

Twelve inpatients with debilitating catatonia and a failed benzodiazepine trial underwent ECT. Ten of these 12 patients initiated RUL placement, one received bifrontal, and another bilateral. All patients achieved resolution of catatonia: 6 patients with RUL alone and 4 who started with RUL later switched to bilateral due to nonresponse. The patient receiving bifrontal switched to bilateral due to nonresponse. Patients with malignant catatonia preferentially responded to bilateral placement. Patients experienced expected side effects from ECT.

RUL ECT was effective for catatonia in pediatric patients and can be considered as initial placement. A switch to bilateral can be considered in nonresponse, similar to current approach for major depression. For malignant catatonia, bilateral placement remains preferential.