Amantadine-Responsive, Benzodiazepine-Resistant Catatonia in an Adolescent With Autism Spectrum Disorder

Area of Science:

• Neuroscience
• Psychiatry
• Pharmacology

Background:

• Catatonia is a severe neuropsychiatric syndrome that can be challenging to diagnose in individuals with autism spectrum disorder (ASD) due to overlapping symptoms.
• Prompt intervention is crucial for pediatric catatonia, with benzodiazepines and electroconvulsive therapy (ECT) as first-line treatments.
• Limited access to ECT and insufficient response to benzodiazepines necessitate exploring alternative pharmacological options.

Purpose of the Study:

• To investigate the efficacy of amantadine as an alternative treatment for catatonia in an adolescent with ASD.
• To evaluate amantadine's potential role when conventional treatments are not feasible or fully effective.

Main Methods:

• A case report of a 15-year-old male with ASD experiencing progressive catatonia.
• Initial treatment involved a lorazepam challenge and high-dose benzodiazepines with insufficient results.
• Amantadine was initiated and titrated due to lack of access to ECT, with outcomes assessed through clinical observation and caregiver reports.

Main Results:

• The patient exhibited significant improvement in catatonic symptoms, including increased speech, improved psychomotor activity, and enhanced social engagement, after initiating amantadine.
• Amantadine treatment led to marked clinical improvement within days.
• Caregiver reports corroborated the observed clinical benefits.

Conclusions:

• Catatonia in ASD may involve dysregulation of dopaminergic, GABAergic, and glutamatergic systems, potentially linked to the excitatory-inhibitory imbalance seen in ASD.
• Amantadine, as an N-methyl-D-aspartate (NMDA) receptor antagonist and dopamine modulator, may help restore neurochemical balance.
• Amantadine presents a viable adjunctive treatment option for catatonia in adolescents with ASD, particularly when benzodiazepines are insufficient and ECT is unavailable.