Ultrabrief and Brief Pulse Right Unilateral Electroconvulsive Therapy for Catatonia Management and Relapse Prevention

Objective: Catatonia is a complex neuropsychiatric syndrome characterized by marked changes in psychomotor function and behavior. The gold standard for managing catatonia is electroconvulsive therapy. Although bitemporal lead placement is traditionally utilized for management, right unilateral lead placement may offer similar remission rates while offering better cognitive outcomes. Currently, unresolved questions impede utilization of right unilateral electroconvulsive therapy for catatonia, such as its efficacy and durability when managing severe manifestations of the syndrome such as delirious mania and neuroleptic malignant syndrome. Providing answers to these questions may improve utilization of right unilateral electroconvulsive therapy for both acute and chronic management. Methods: A case series of patients with catatonia was compiled from a retrospective review of all electroconvulsive therapy performed at our institution over the last 7 years. Response and remission rates were determined by a reviewer blinded to treatment modality and hypotheses. Results: Of patients, 90% with catatonia responded to treatment with right unilateral lead placement, while 70% remitted. All patients with delirious mania and neuroleptic malignant syndrome remitted from treatment with ultrabrief pulse right unilateral electroconvulsive therapy. All patients treated with right unilateral electroconvulsive therapy had stable or improved cognition over the course of their treatments. Over a span of one hundred plus patient-months, no patient treated with continuation or maintenance therapy required rehospitalization within a month of their last treatment. Conclusions: Right unilateral electroconvulsive therapy provides a rapid, consistent, and durable response for managing a variety of forms of catatonia and should be more readily considered for both acute and chronic management.