Retrospective chart review of cases of steroid-responsive catatonia: exploring a potential autoimmune aetiology

Catatonia, a neuropsychiatric syndrome, can be associated with inflammatory conditions of the central nervous system.

To explore steroid-responsive catatonia with possible autoimmune origins.

A retrospective investigation was conducted of clinical and paraclinical features, including imagining, serum, and cerebrospinal fluid findings in ten patients presenting with subacute onset catatonia and treated with steroid pulse therapy between January 2022 and January 2024.

A retrospective chart review identified ten patients (of a total of 56) with steroid-responsive subacute onset catatonia. Catatonia types varied. All patients were positive for delirium and psychotic symptoms. Imaging and cerebrospinal fluid results indicated non-specific signs of central nervous system inflammation. Intravenous 1 g methylprednisolone pulse therapy resulted in complete remission in all patients. Autoantibodies for limbic and paraneoplastic encephalitis were negative for all patients. None of the patients fulfilled the criteria for definite autoimmune encephalitis or autoantibody-negative probable autoimmune encephalitis.

Diagnosis of autoimmune catatonia is challenging without autoantibody markers, but steroid responsiveness, combined with clinical and paraclinical features, may suggest an autoimmune mechanism.