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No. 1 (2024)

PRACTICE

Clinical Case of Usage of Transcranial Magnetic Stimulation (TMS) for the Treatment of Catatonia (Case Report and Analysis)

https://doi.org/10.21265/PSYPH.2024.97.71.006

Published 2024-03-30

  • N.V. Maslenikov
    • ,
  • E.E. Tsukarzi
    • ,
  • S.N. Mosolov

N.V. Maslenikov
Moscow Research Institute of Psychiatry — branch of the V.P. Serbsky National Medical Research Center for Psychiatry and Narcology of the Ministry of Health of the Russian Federation

E.E. Tsukarzi
Moscow Research Institute of Psychiatry — branch of the V.P. Serbsky National Medical Research Center for Psychiatry and Narcology of the Ministry of Health of the Russian Federation

S.N. Mosolov
Moscow Research Institute of Psychiatry — branch of the V.P. Serbsky National Medical Research Center for Psychiatry and Narcology of the Ministry of Health of the Russian Federation; Russian Medical Academy of Continuous Professional Education of the Ministry of Health of the Russian Federation

Abstract

Catatonia is a potentially life-threatening syndrome which occurs in different diseases such as schizophrenia, affective disorders, organic and somatic conditions, intoxications. Benzodiazepines and electroconvulsive therapy (ECT) are the methods of choice for the treatment of catatonia as stated in national and international guidelines. At the same time pharmacotherapy is not always effective and ECT is not readily available and sometimes contraindicated. Such a noninvasive brain stimulation method as transcranial magnetic stimulation (TMS) is considered as an alternative to ECT. Modulation of neuronal activity of such brain areas as dorsolateral prefrontal cortex and orbitofrontal cortex by electromagnetic pulses enables to act indirectly upon subcortical regions which involved in pathogenesis of catatonia. This article reviews literature data concerning application of TMS in patients with catatonia, case report and its analysis is provided. A 24-year-old male patient with diagnosis “Schizophrenia, catatonic type” (ICD-10 - F20.2) underwent 21 sessions of 15 Hz TMS (6 on left dorsolateral prefrontal cortex and 15 bilateral) of 3600 pulses. After the treatment course Bush-Francis Catatonia Rating Scale (BFCRS) score decreased from 22 to 10. Taking into account absence of randomized controlled trials, level of evidence of TMS effectiveness in catatonia is considered low. Nevertheless, different protocols of TMS in patients with catatonia require further research. Moreover, TMS might be considered as an option of supporting treatment after a successful course of ECT.

Keywords

catatonia, schizophrenia, transcranial magnetic stimulation, TMS, electroconvulsive therapy, ECT, dorsolateral prefrontal cortex

PDF (Русский)

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