Catatonia and Transcranial Magnetic Stimulation

Ms. A, an 18-year-old woman, was brought to the hospital in a catatonic state, according to DSM-IV criteria. She had no personal or family history of psychiatric disease. She was socially involved and was attending school regularly. Seven months before, she had experienced social withdrawal, a decline in school performance, panic attacks, and marked behavioral disturbances. Four days before hospitalization, she had developed acute catatonic syndrome.

When we examined Ms. A, her catatonic symptoms were found to involve mutism, waxy flexibility, negativism, rigidity, and catalepsy. Her symptoms were rated with the Bush Francis Catatonia Rating Scale (6) at baseline and every 3 days thereafter. After the failure of a short trial (3 days) of lorazepam, she was treated with fast repetitive TMS of the left dorsolateral prefrontal cortex for 2 weeks (10 sessions, 1600 stimuli/day, 10 Hz, 80% of the motor threshold).

Almost all of her catatonic symptoms had disappeared by the end of the TMS treatment, allowing a diagnosis of schizophrenia, according to the clinical picture (auditory hallucinations and delusions). The severity of the catatonic symptoms on the catatonia rating scale had dropped from 19 at baseline to 3 by days 12 and 15. Antipsychotic medication (amisulpride, 600 mg b.i.d.) was then initiated. Ms. A was discharged 4 weeks later.