Identifying and Treating Catatonia in Children with Neurodevelopmental Disorders: Case Series From Canada

 Out on PubMed, from authors in Nova Scotia, is this case series

Identifying and treating catatonia in children with neurodevelopmental disorders: A case series.

Nejati N, Etches S.J Can Acad Child Adolesc Psychiatry. 2024 Nov;33(3):215-222. Epub 2024 Nov 1.PMID: 39534778

The abstract is copied below:

Catatonia is a neuropsychiatric syndrome that is an increasingly recognized cause of acute behavioural changes in children and adolescents with neurodevelopmental disorders (NDD). Literature suggests that catatonia can present differently in this population and can be missed due to diagnostic overshadowing. Catatonia is a treatable condition, and management strategies in children with NDD include benzodiazepines and electroconvulsive therapy (ECT). Untreated, it can cause significant morbidity including severe medical complications, and therefore timely recognition and management of catatonia in children and adolescents with NDD is essential. In this case series, we present three cases of children ages 7, 14, and 10, with diagnoses of autism spectrum disorder, Down syndrome, and Prader-Willi syndrome, respectively. All were admitted to a pediatric inpatient unit for acute behavioural regression. Each had symptoms consistent with catatonia, resulting in trials of benzodiazepine therapy with inadequate response, and were then treated with bilateral ECT. In all cases, marked improvement was noted after ECT, with no apparent adverse effects. The cases are used to highlight the nuances of diagnosis and management of catatonia in children and adolescents with NDD. This includes insights on how presentations of catatonia may differ in this population, challenges with the use of available diagnostic tools, and how these patients may respond differently to recommended treatments such as benzodiazepines. The case series aims to increase clinicians' awareness of pediatric catatonia when children and adolescents with NDD present with acute behavioural changes, and to encourage consideration of the full spectrum of treatments, including bilateral ECT.

Keywords: case series; catatonia; electroconvulsive therapy; neurodevelopmental disorders.

The article is here.

And from the text:

This is an extremely thoughtful and well written case series of catatonic presentations in children with neurodevelopmental disorders. The remarkable efficacy of ECT, and the struggle to get to it in the treatment sequence, are notable. The clinical descriptions here are excellent, and vividly convey the struggles of these children.

There is also one of the cutest sentences in the psychiatric literature:

Parent and school collateral information suggested prior difficulties with reading and with waiting her turn, but no assessment for NDD had taken place. 

One suggestion for improvement would be to have included more details of the ECT technical parameters, as well as the specifics of anesthesia medications and technique, given the ages of the patients.

Kudos to our Canadian colleagues for this important contribution the pediatric ECT literature.