P-TS003. Treatment of stuporous catatonia with repetitive transcranial magnetic stimulation (RTMS) therapy in a filipino adult patient: a case report

Abstract

Introduction. Catatonia is a syndrome of altered motor behavior and can occur in patients with underlying psychiatric and general medical disorders. Benzodiazepines are considered as the first line treatment for this condition while electroconvulsive therapy is performed in refractory cases that did not respond to pharmacologic therapy. Repetitive transcranial magnetic stimulation (rTMS) is a non-invasive technique for brain stimulation and is being used as an alternative treatment for psychiatric conditions. Results. Our patient is a 30-year-old female admitted to our hospital due to a two-day history of mutism, increased sleeping time, restlessness, and behavioral changes. Laboratory tests, cranial magnetic resonance imaging with contrast and electroencephalogram were normal. A lumbar puncture was performed and cerebrospinal fluid analysis was negative for infectious agents. The patient was referred to psychiatry service and was assessed as a case of brief psychotic disorder presenting as stuporous catatonia. She was administered with intravenous diazepam, oral olanzapine, and vortioxetine. Despite pharmacologic therapy, the patient did not show significant improvement of symptoms. Therapy with rTMS was started on the tenth day of admission. After completion of 10 sessions, the patient was able to ambulate without assistance, with marked improvement of speech and motor strength. On follow up, there was complete disappearance of catatonic symptoms. Conclusion. Our case highlights repetitive transcranial magnetic stimulation as a potential alternative treatment option for patients with stuporous catatonia who did not respond to pharmacologic intervention or when electroconvulsive therapy is not available.