Benzodiazepine reduction and a generalized tonic-clonic seizure with therapeutic benefit in catatonia associated with autism spectrum disorder (Raheem, 2022)

Parry Sarah Raheem Ali Williams Elliot Rogers Jonathan P. 

The Journal of ECT 2022;38(3): 218-219. 

Available online at this link 

Presents a case report of 21-year-old woman with a history of preterm birth, patent ductus arteriosus, neonatal intraventricular hemorrhage, chronic compensated hydrocephalus, prediabetes mellitus, polycystic ovarian syndrome, mild intellectual disability, and autism spectrum disorder was referred to outpatient mental health services. Her only previous seizure had been age 15 years, while taking sertraline and quetiapine and she was not subsequently on anticonvulsants. She had previously been treated since the age of 13 years for social withdrawal, poor sleep, reduced appetite, and hearing voices after a suspected bullying incident on a school trip, which gradually deteriorated, characterized by poor occupational function, lack of motivation, and mutism. Previous trials of sertraline, quetiapine, risperidone, and aripiprazole were unsuccessful. This report supports the notion that ECT should be considered early as a potential therapeutic modality in catatonia in autism even when there is no immediate risk to life. It also provides a caution about gradual titration of benzodiazepines in catatonia, as it can cause tolerance and may risk withdrawal seizures, especially in individuals with risk factors for seizures. Finally, this case illustrates a complex relationship between seizures and catatonia, because catatonia can be a manifestation of nonconvulsive status epilepticus. (PsycInfo Database Record (c) 2022 APA, all rights reserved)