OTHR-07. LIFE THREATENING CATATONIA AND THE USE OF ELECTROCONVULSIVE THERAPY IN A PATIENT WITH RELAPSED MEDULLOBLASTOMA

Abstract

Abstract Medulloblastoma is one of the most common malignant brain tumors in the pediatric population and with multimodal therapy the majority of patients will be cured, but patients experience significant morbidity related to the disease and therapy. Catatonia is a life-threatening psychomotor disorder that has rarely been described in the pediatric population and is likely under recognized. Catatonia is a treatable condition using benzodiazepines as first line with electroconvulsive therapy (ECT) used for patients who do not respond or have life threatening malignant catatonia. In the medical literature there are very few papers to inform on the safety of using ECT in patients who have received radiation in the past or are undergoing chemotherapy. We describe a patient in remission of his medulloblastoma who presented with refractory catatonia who needed lifesaving ECT, then had metastatic recurrence of his medulloblastoma. The patient was initially diagnosed with group 4 medulloblastoma at 14 – he was treated with high-risk therapy to metastatic sites of disease at diagnosis as per COG ACNS 0332 with a combination of surgery, chemotherapy and craniospinal radiation and a boost to the primary tumor and metastatic sites of disease. Approximately 18 months after the end of therapy he was diagnosed with treatment refractory catatonia and needed to be started on ECT with a good response. 6 months after presentation of catatonia, the patient unfortunately had a relapse of his medulloblastoma in his left temporal lobe and is now actively getting ECT and chemotherapy at the same time without complications. The description of this patient will add to the sparse body of evidence that it is likely safe to be able to deliver chemotherapy at the same time as ECT.