Malignant catatonia or nonconvulsive status epilepticus?

Abstract

In the July 1994 issue of the Mayo Clinic Proceedings (pages 645 to 650), Boeve and colleagues diagnosed malignant catatonia in a 69-year-old man with progressive behavioral changes and depression, who ultimately became rigid, tremulous, and mute. He “experienced a striking but shortlived improvement” after 1 mg of lorazepam was given intravenously before lumbar puncture. Later, autonomic instability with blood pressure changes, tachycardia, altered respiration, and fever developed. Emergency electroconvul-sive therapy was necessary. Although malignant catatonia was diagnosed, we suggest nonconvulsive status epilepticus as an alternative explanation. Our own experience1Dunne JW Summers QA Stewart-Wynne EG Non-convulsive status epilepticus: a prospective study in an adult general hospital.Q J Med. 1987; 62: 117-126PubMed Google Scholar and that of others2Cascino GD Nonconvulsive status epilepticus in adults and children.Epilepsia. 1993; 34: S21-S28Crossref PubMed Scopus (100) Google Scholar indicates that nonconvulsive status epilepticus may produce a variable alteration of consciousness and behavior, rigidity, mutism, catatonic posturing, and autonomic signs. These changes may occur unaccompanied by obvious convulsive seizures or a history of epilepsy. The patient's striking response to the intravenous administration of lorazepam supports our alternative suggestion. Although the studies that the authors performed were described in detail, electroencephalography was not mentioned. Perhaps this study was done but was omitted in the case report. Nonetheless, we wish to focus attention on the importance of the differential diagnosis of nonconvulsive status epilepticus in that patient. Sometimes, several electroencephalograms are necessary in order to make this diagnosis. Dr. Rummans repliesMayo Clinic ProceedingsVol. 70Issue 1PreviewI thank Drs. Heye and Dunne for their comments about our case of malignant catatonia. We were amiss for not including the results of the electroencephalographic examination that was performed as part of the comprehensive neurologic and medical assessment of our patient. The electroencephalographic findings revealed a dysrhythmia, grade 2, consistent with a diffuse disturbance of cerebral function rather than nonconvulsive status epilepticus. Full-Text PDF