(018) Well, that shocked me: the relationship between Catatonia and Epileptic Seizures as illustrated by case series

Abstract:
Background
The association between epilepsy and catatonia dates to the 19th century with Kahlbaum’s definition of catatonia and its association with “organic brain disease” (Gadelho, 2022). Beluffi further explored this: looking at related structures of both epilepsy and catatonia including the mesencephalon (Gadelho, 2022). De Mille, in 1962 connected the two conditions by studying post lobectomy seizures and their relationship to new onset catatonia (Gadelho, 2022). Case reports indicate possible connections between epileptic foci, neuronal inflammation and catatonic presentation (Repchak, 2016). In this presentation we will discuss the pathophysiologic relationship of catatonia and seizures utilizing case examples to illustrate these connections.  Furthermore, we will explore benefits and limitations to diagnosis and treatment.  



Cases
We present four cases illustrating the relationship between catatonia and epileptic seizures. 

Our first case is a patient with a history of functional neurologic disorder presenting with hyperactive catatonia later diagnosed with temporal lobe epilepsy only after transsphenoidal electroencephalogram (EEG). The next case is a young female with a history of epilepsy presented as altered and diagnosed with functional neurologic disorder without performing EEG, also found to have new onset catatonia in setting of medication non-adherence. These two cases illustrate the role of the consultation liaison psychiatrist as an advocate for seizure work up for atypical presentations of seizures, such as catatonia.




The third case is a young man with a history of epilepsy found to have subclinical seizures presenting as hypoactive catatonia. Diagnosis occurred only after multiple days of EEG monitoring and response to electroconvulsive treatment. This case highlights the intense collaboration required between neurology and psychiatry.

Our final case is a pediatric patient diagnosed with epilepsy at age 16 that progressed to include mood instability, aggression, and subsequently catatonia and psychosis, in the setting of breakthrough seizures, non-epileptic episodes, medication changes, and psychosocial stressors. She was treated on a medical unit with psychiatry consultation and subsequently on an inpatient psychiatric unit. This case demonstrates the medical and psychiatric considerations regarding the advantages and disadvantages of medical versus psychiatric admission.

Discussion
Our goal in this presentation is to identify pathophysiologic relationships between epileptic seizures and catatonic symptomatology. We will compare these cases and hope to demonstrate similarities regarding seizures loci. In addition, this presentation will focus on pathophysiologic similarities between epileptic seizures, neuroinflammation and catatonic symptomatology.  



Implications
By the end of our presentation, we aim to address the need for pro-active advocacy regarding seizure work up, especially with the possibility of nonclinical seizures presenting with catatonic symptomatology.  



References 
Gadelho, L. S., & Marques, J. G. (2022). Catatonia associated with epileptic seizures: A systematic review of case reports. Epilepsy Research, 186, 107016. 



Repchak, A. T., & Quinn, D. K. (2016). Epileptic catatonia: a case series and systematic review. Psychosomatics, 57(2), 217-225. 


Presentation Eligibility: Not previously published or presented

Diversity, Equity, and Inclusion: This presentation advocates for further work up in patients often dismissed for "odd or bizarre" neurologic presentations, and consequently, misdiagnosed as "functional". In addition, this work features the advocacy and leadership of three women psychiatrists who serve this patient population.