A pediatric case describes persistent malignant catatonia despite several treatments, followed by improvement after ECT. The sequence cannot isolate one intervention from the evolving autoimmune illness.
The clinical sequence
A sixteen-year-old girl with confirmed anti-NMDA receptor encephalitis developed severe catatonia and autonomic instability. Treatment included corticosteroids, plasma exchange, intravenous immunoglobulin, rituximab, and high-dose benzodiazepines.
Catatonia persisted. The authors reported a robust response after ECT began and return to baseline cognitive and motor function six weeks after eight treatments.
A response and its limits
This is one clinical course, without a concurrent comparison group. Delayed effects of immune therapy, supportive care, and the illness trajectory could contribute to recovery. It cannot estimate how often benzodiazepine-resistant catatonia responds to ECT.
The report also does not show that benzodiazepines failed to provide any symptom benefit or that they were inappropriate earlier in the course.
Clinical-record interpretation
Track autoimmune findings, motor signs, autonomic changes, medication exposure, and ECT timing separately. Persistent catatonia in this setting is not simply evidence of insufficient sedation. The case supports attention to treatment-resistant syndromes while leaving comparative efficacy and individual causal attribution unresolved.
Source paper
Original analysis of the supplied journal article, identified as PMC6378721.
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