Rinsho Shinkeigaku (Clinical Neurology)

Case Report

Non-convulsive status epilepticus manifesting as ictal catatonia: a case report

Yuki Sanada, M.D.1), Shunsuke Kajikawa, M.D.1), Katsuya Kobayashi, M.D., Ph.D.1), Akira Kuzuya, M.D., Ph.D.1), Riki Matsumoto, M.D., Ph.D.3), Akio Ikeda, M.D., Ph.D.2) and Ryosuke Takahashi, M.D., Ph.D.1)

1) Department of Neurology, Kyoto University Graduate School of Medicine
2) Department of Epilepsy, Movement Disorders and Physiology, Kyoto University Graduate School of Medicine
3) Division of neurology, Kobe University Graduate School of Medicine

A 66 year-old right-handed female was admitted to our hospital presenting with recurrent episodes of catatonic symptoms consisting of stupor, waxy flexibility, and catalepsy lasting about 5-20 minutes. A brain MRI showed no significant abnormalities. An scalp-electroencephalography (EEG) concurrent with the symptoms showed ictal EEG activities arising from the left fronto-central area, which evolved into the bilateral frontal and bilateral parietal areas together. An 18F-fluorodeoxy glucose positron emission tomography (18F-FDG-PET) 4 days after improvement of the symptoms showed hypermetabolism in the bilateral frontal and parietal lobes. Her catatonic symptoms are assumed to be due to non-convulsive status epilepticus (NCSE), namely ictal catatonia. The introduction of several anti-epileptic drugs improved the symptoms and normalized the EEG and FDG-PET findings. NCSE must be considered as one of the underlying state of catatonic symptoms because the treatment plan for acute and chronic state is different from that of catatonic syndrome due to psychiatric disorders.
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(CLINICA NEUROL, 61: 385|391, 2021)
key words: non-convulsive status epilepticus, 18F-FDG-PET, ictal catatonia, catatonic syndrome

(Received: 20-Oct-20)