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Pediatric catatonia: A case report and review of the management
Alison Thornton1, Russell Birkett1,2
1Sheffield Children's NHS Foundation Trust Sheffield UK.
Insights
Pediatric catatonia, a rare condition, requires more research for effective management. This case study shows lorazepam can successfully treat catatonia symptoms in adolescents, highlighting the need for treatment guidelines.
Area of Science:
- Pediatric neurology
- Psychiatry
- Clinical case study
Background:
- Catatonia is a neuropsychiatric syndrome characterized by a lack of responsiveness to external stimuli while awake.
- It manifests with motor, speech, and behavioral changes, with limited research in pediatric populations.
- Existing literature offers minimal guidance on catatonia causes and management in children.
Purpose of the Study:
- To present a case of pediatric catatonia and discuss its management.
- To highlight the lack of established guidelines for pediatric catatonia treatment.
- To emphasize the need for further research in this area.
Main Methods:
- A case presentation of a 13-year-old male with sudden onset distress and catatonic symptoms.
- Diagnostic workup including imaging and blood tests to rule out physical causes.
- Pharmacological intervention with lorazepam and careful titration for symptom management.
Main Results:
- The patient presented with severe catatonic symptoms including stupor, mutism, and posturing.
- Lorazepam administration led to rapid improvement in catatonic symptoms, enabling oral intake and mobilization.
- Symptom recurrence upon lorazepam reduction indicated the need for careful titration and ongoing management.
Conclusions:
- This case underscores the efficacy of lorazepam in treating pediatric catatonia.
- The study highlights a significant gap in clinical guidelines for managing catatonia in children.
- Further research is crucial for developing evidence-based protocols for pediatric catatonia.
Background:
Catatonia is when someone does not respond to stimuli or their environment whilst awake. Catatonia can present in a variety of ways, including a change in movement, speech, and behavior. There is limited research on the causes and management of catatonia in an adult population and even more so in the pediatric population.
Case Presentation:
A 13-year-old presented with a 2-week sudden onset history of distress and preoccupation regarding a child being in danger. Over the next few weeks, he was represented on multiple occasions and had a rapid weight loss due to refusing oral intake. He displayed increasing preoccupations and was admitted for intravenous fluids and commenced on nasogastric feeds. He declined rapidly, presenting with symptoms of catatonia, including stupor, catalepsy, mutism, and posturing. Physical health causes for this presentation were ruled out with imaging and bloods completed, and he was trialled on lorazepam. He responded well to the lorazepam, and after 5 days, the nasogastric tube was removed, and he commenced eating, drinking, communicating, and mobilizing. The lorazepam was reduced, and his symptoms reemerged. The lorazepam was titrated back up and reduced again at a slower rate.
Conclusion:
Whilst managing this case, it was noted that there is a lack of guidance available for catatonia in both adult and pediatric populations. There is particularly a lack of guidance on how to titrate onto and off lorazepam. This case highlighted a need for further research to support the development of guidelines for the management of pediatric catatonia.
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