Skip to main content
SpringerLink
Log in

Electroconvulsive therapy resolves cortical inhibition and manneristic omissions in a chronic catatonic patient

  • Biological Psychiatry - Short communication
  • Published:
Journal of Neural Transmission Aims and scope Submit manuscript

Abstract

We investigated a patient with severe catatonic schizophrenia (manneristic catatonia according to Karl Leonhard) treated with electroconvulsive therapy (ECT) after pharmacological approaches did not result in any clinical improvement. Before and after nine ECT sessions a double-pulse transcranial magnetic stimulation (TMS) paradigm was used to measure intracortical inhibition (ICI) which has been shown to be reduced in a significant proportion of patients with schizophrenia. Although the patient showed no remission regarding some psychomotor aspects after ECT, we found an increase in ICI and a remarkable clinical improvement of catatonic omissions which might be due to changes in the GABAergic system.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Notes

  1. Longer IPIs lead to increased test pulse motor responses, i.e. intracortical facilitation.

References

  • Bajbouj M, Lang UE, Niehaus L, Hellen FE, Heuser I, Neu P (2006) Effects of right unilateral electroconvulsive therapy on motor cortical excitability in depressive patients. J Psychiatr Res 40:322–327

    Article  PubMed  Google Scholar 

  • Benes FM, Berretta S (2001) GABAergic interneurons: implications for understanding schizophrenia and bipolar disorder. Neuropsychopharmacology 25:1–27

    Article  CAS  PubMed  Google Scholar 

  • Chen J, Tsang SY, Zhao CY, Pun FW, Yu Z, Mei L, Lo WS, Fang S, Liu H, Stöber G, Xue H (2009) GABRB2 in schizophrenia and bipolar disorder: disease association, gene expression and clinical correlations. Biochem Soc Trans 37:1415–1418

    Article  CAS  PubMed  Google Scholar 

  • Consoli A, Boulicot V, Cornic F, Fossati P, Barbeau M, Cohen D (2009) Moderate clinical improvement with maintenance ECT in a 17-year-old boy with intractable catatonic schizophrenia. Eur Child Adolesc Psychiatry 18:250–254

    Article  PubMed  Google Scholar 

  • Daskalakis ZJ, Christensen BK, Chen R, Fitzgerald PB, Zipursky RB, Kapur S (2002a) Evidence for impaired cortical inhibition in schizophrenia using transcranial magnetic stimulation. Arch Gen Psychiatry 59:347–354

    Article  PubMed  Google Scholar 

  • Daskalakis ZJ, Christensen BK, Fitzgerald PB, Roshan L, Chen R (2002b) The mechanisms of interhemispheric inhibition in the human motor cortex. J Physiol 543:317–326

    Article  CAS  PubMed  Google Scholar 

  • Fitzgerald PB, Brown TL, Daskalakis ZJ, Kulkarni J (2002a) A transcranial magnetic stimulation study of inhibitory deficits in the motor cortex in patients with schizophrenia. Psychiatry Res 114:11–22

    Article  PubMed  Google Scholar 

  • Fitzgerald PB, Brown TL, Daskalakis ZJ, Kulkarni J (2002b) A transcranial magnetic stimulation study of the effects of olanzapine and risperidone on motor cortical excitability in patients with schizophrenia. Psychopharmacology (Berl) 162:74–81

    Article  CAS  Google Scholar 

  • Florian J, Muller-Dahlhaus M, Liu Y, Ziemann U (2008) Inhibitory circuits and the nature of their interactions in the human motor cortex a pharmacological TMS study. J Physiol 586:495–514

    Article  CAS  PubMed  Google Scholar 

  • Haraldsson HM, Ferrarelli F, Kalin NH, Tononi G (2004) Transcranial Magnetic Stimulation in the investigation and treatment of schizophrenia: a review. Schizophr Res 71:1–16

    Article  PubMed  Google Scholar 

  • Iseki K, Ikeda A, Kihara T, Kawamoto Y, Mezaki T, Hanakawa T, Hashikawa K, Fukuyama H, Shibasaki H (2009) Impairment of the cortical GABAergic inhibitory system in catatonic stupor: a case report with neuroimaging. Epileptic Disord 11:126–131

    PubMed  Google Scholar 

  • Kujirai T, Caramia MD, Rothwell JC, Day BL, Thompson PD, Ferbert A, Wroe S, Asselman P, Marsden CD (1993) Corticocortical inhibition in human motor cortex. J Physiol 471:501–519

    CAS  PubMed  Google Scholar 

  • Leonhard K (1999) Classification of endogenous psychoses and their differentiated etiology. Springer, Wien

    Google Scholar 

  • Lo WS, Harano M, Gawlik M, Yu Z, Chen J, Pun FW, Tong KL, Zhao C, Ng SK, Tsang SY, Uchimura N, Stöber G, Xue H (2007) GABRB2 association with schizophrenia: commonalities and differences between ethnic groups and clinical subtypes. Biol Psychiatry 61:653–660

    Article  CAS  PubMed  Google Scholar 

  • Lopez-Garcia P, Chiclana C, Gonzalez R (2007) Combined use of ECT with aripiprazole. World J Biol Psychiatry 10:1–2

    Google Scholar 

  • Northoff G (2000) Brain imaging in catatonia: current findings and a pathophysiologic model. CNS Spectr 5:34–46

    CAS  PubMed  Google Scholar 

  • Northoff G, Steinke R, Czcervenka C, Krause R, Ulrich S, Danos P, Kropf D, Otto H, Bogerts B (1999) Decreased density of GABA-A receptors in the left sensorimotor cortex in akinetic catatonia: investigation of in vivo benzodiazepine receptor binding. J Neurol Neurosurg Psychiatry 67:445–450

    Article  CAS  PubMed  Google Scholar 

  • Palmio J, Huuhka M, Saransaari P, Oja SS, Peltola J, Leinonen E, Suhonen J, Keranen T (2005) Changes in plasma amino acids after electroconvulsive therapy of depressed patients. Psychiatry Res 137:183–190

    Article  CAS  PubMed  Google Scholar 

  • Pascual-Leone A, Manoach DS, Birnbaum R, Goff DC (2002) Motor cortical excitability in schizophrenia. Biol Psychiatry 52:24–31

    Article  PubMed  Google Scholar 

  • Sackeim HA (1999) The anticonvulsant hypothesis of the mechanisms of action of ECT: current status. J ECT 15:5–26

    CAS  PubMed  Google Scholar 

  • Seethalakshmi R, Dhavale S, Suggu K, Dewan M (2008) Catatonic syndrome: importance of detection and treatment with lorazepam. Ann Clin Psychiatry 20:5–8

    Article  CAS  PubMed  Google Scholar 

  • Stöber G, Jungkunz G, Franzek E, Beckmann H (1996) Manneristic catatonia. A psychotropic drug refractory chronic progressive course. Fortschr Neurol Psychiatr 64:250–260

    Article  PubMed  Google Scholar 

  • Suzuki K, Awata S, Matsuoka H (2003) Short-term effect of ECT in middle-aged and elderly patients with intractable catatonic schizophrenia. J ECT 19:73–80

    Article  PubMed  Google Scholar 

  • Suzuki K, Awata S, Matsuoka H (2004) One-year outcome after response to ECT in middle-aged and elderly patients with intractable catatonic schizophrenia. J ECT 20:99–106

    Article  PubMed  Google Scholar 

  • Suzuki K, Itou K, Takano T, Harada N, Awata S, Matsuoka H (2006) Catatonic stupor superimposed on hereditary spinocerebellar degeneration resolved with electroconvulsive therapy. Prog Neuropsychopharmacol Biol Psychiatry 30:1179–1181

    Article  PubMed  Google Scholar 

  • Werhahn KJ, Kunesch E, Noachtar S, Benecke R, Classen J (1999) Differential effects on motorcortical inhibition induced by blockade of GABA uptake in humans. J Physiol 517(Pt 2):591–597

    Article  CAS  PubMed  Google Scholar 

  • Ziemann U (2004) TMS and drugs. Clin Neurophysiol 115:1717–1729

    Article  CAS  PubMed  Google Scholar 

  • Ziemann U, Lonnecker S, Steinhoff BJ, Paulus W (1996) The effect of lorazepam on the motor cortical excitability in man. Exp Brain Res 109:127–135

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgments

The study was partly supported by the Deutsche Forschungsgemeinschaft (KFO 125, SFB TRR 58 C4). We gratefully acknowledge the support of Dr. Ann-Christine Ehlis.

Author information

Authors and Affiliations

  1. Department of Psychiatry, Psychosomatics and Psychotherapy, University Hospital Wuerzburg, Fuechsleinstr. 15, 97080, Wuerzburg, Germany

    T. Dresler, A. S. Giani, C. Reinsberger & G. Stöber

  2. Department of Neurology, University Hospital Wuerzburg, Wuerzburg, Germany

    C. Reinsberger

  3. Department of Neurology, Brigham and Women’s Hospital, Harvard Medical School, Boston, USA

    C. Reinsberger

  4. Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital Wuerzburg, Wuerzburg, Germany

    P. Scheuerpflug

  5. Max Planck Institute for Biological Cybernetics, Tuebingen, Germany

    A. S. Giani

  6. Department of Psychiatry and Psychotherapy, University of Tuebingen, Tuebingen, Germany

    A. J. Fallgatter

Authors
  1. T. Dresler
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. A. S. Giani
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. C. Reinsberger
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. P. Scheuerpflug
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. G. Stöber
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. A. J. Fallgatter
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to T. Dresler.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Dresler, T., Giani, A.S., Reinsberger, C. et al. Electroconvulsive therapy resolves cortical inhibition and manneristic omissions in a chronic catatonic patient. J Neural Transm 117, 1209–1212 (2010). https://doi.org/10.1007/s00702-010-0467-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00702-010-0467-7

Keywords

Search

Navigation