ECT in Adult-Onset Niemann-Pick Type C

Out on PubMed is this case report written by a medical student and 2 attendings from the University of South Florida:
Diagnostic Challenges and Treatment of the Neuropsychiatric Symptoms of Adult-Onset Niemann-Pick Type C With Electroconvulsive Therapy.

Foels R, Hartney K, Cohen-Oram A.Psychosomatics. 2020 Jun 21:S0033-3182(20)30197-3. doi: 10.1016/j.psym.2020.06.011. Online ahead of print.PMID: 32680690

From the text:

We present a novel case in which treatment with ECT resulted in symptomatic improvement in a patient with adult-onset NPC. Our patient presented initially with mild attention problems and eventual progressed to an episode of acute psychosis followed by encephalopathy with alternating catatonic and hyperactive features. She was trialed on multiple medications in an attempt to manage her psychiatric symptoms including risperidone, lurasidone, lamotrigine, trazodone, and lorazepam with minimal-to-no benefits in alleviation of her symptoms and increased catatonic features with neuroleptics. The eventual decision was made to proceed with ECT owing to the persistence and severity of her being encephalopathic and catatonic. She saw marked improvement in her symptoms after just 1 ECT treatment. Her response continued gradually throughout all 18 treatments and benefits have been maintained over 4 months after discontinuation of ECT. Although she has had relapses in her encephalopathic symptoms during the course of ECT treatments, additional ECT treatments following have been the most effective in returning her to her new baseline and allowing her to remain functional during this time.

This is an instructive, carefully prepared case report documenting the successful use of ECT for the neuropsychiatric manifestations of a rare genetic disorder. The long path to accurate final diagnosis is well described, including a detour to consider autoimmune encephalitis. The improvement after the first ECT is also noteworthy.