Efficacy of Transcranial Direct-Current Stimulation in Catatonia: A Review and Case Series

Abstract

Catatonia is a severe neuropsychiatric syndrome, usually treated by benzodiazepines and electroconvulsive therapy. However, therapeutic alternatives are limited, which is particularly critical in situations of treatment resistance or when electroconvulsive therapy is not available. Transcranial direct-current stimulation (tDCS) is a promising non-invasive neuromodulatory technique that has shown efficacy in other psychiatric conditions. We present the largest case series of tDCS use in catatonia, consisting of eight patients in whom tDCS targeting the left dorsolateral prefrontal cortex and temporoparietal junction was employed. We used a General Linear Mixed Model to isolate the effect of tDCS from other confounding factors such as time (spontaneous evolution) or co-prescriptions. The results indicate that tDCS, in addition to symptomatic pharmacotherapies such as lorazepam, seems to effectively reduce catatonic symptoms. These results corroborate a synthesis of five previous case reports of catatonia treated by tDCS in the literature. However, the specific efficacy of tDCS in catatonia remains to be demonstrated in a randomized controlled trial. The development of therapeutic alternatives in catatonia is of paramount importance.

Keywords: brain stimulation; case series; catatonia; schizophrenia; transcranial direct-current stimulation.

Conflict of interest statement

JR has held an advisory meeting with representatives from Promentis Pharmaceuticals, Inc. regarding drug development in an unpaid capacity. FV been invited to scientific meetings, consulted and/or served as speaker and received compensation by Lundbeck, Servier, Recordati, Janssen, Otsuka, Chiesi, and LivaNova. RG has received compensation as a member of the scientific advisory board of Janssen, Lundbeck, Roche, SOBI, Takeda. He has served as consultant and/or speaker for Astra Zeneca, Boehringer-Ingelheim, Pierre Fabre, Lilly, Lundbeck, LVMH, MAPREG, Novartis, Otsuka, Pileje, SANOFI, Servier and received compensation, and he has received research support from Servier. MP has served as speaker and received compensation by Lundbeck, Janssen, and LivaNova. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Copyright © 2022 Haroche, Giraud, Vinckier, Amad, Rogers, Moyal, Canivet, Berkovitch, Gaillard, Attali and Plaze.

Figures

FIGURE 1

Literature review flowchart.

FIGURE 2

Individual data about the evolution of BFCRS score according to the cumulative number of tDCS sessions. Case 2, for whom catatonia severity was assessed using Kanner scale, is not shown in this figure. In black, the regression line of the scatter plot.

FIGURE 3

Effect of tDCS and other factors on BFCRS. Coefficient estimates of the general linear mixed model. TDCS regressor was expressed in number of sessions since the beginning of the course, meaning that each tDCS session resulted in a 0.45 decrease of BFCRS score. Time was expressed in days. For benzodiazepine and antipsychotic a proxy for concentration was computed (see section “Materials and Methods”). For comparability of estimate size, benzodiazepine regressor was expressed in centigram (10 mg) of diazepam equivalent while antipsychotic regressor was expressed centigram of chlorpromazine equivalent. Error bars represent standard errors of coefficient estimates. ***Statistically significant.