Catatonia following surgery for temporal lobe epilepsy successfully treated with electroconvulsive therapy

Catatonia is a psychomotor and behavioral syndrome associated with mood disorders, psychotic disorders, neurological disease, and general medical conditions. Catatonia has also been described as a manifestation of partial onset seizures. We describe a case of catatonia following successful epilepsy surgery. A 38-year-old patient with congenital hydrocephalus and left hippocampal sclerosis underwent selective left amygdalohippocampectomy for medically refractory seizures. Three days after surgery, she became progressively less interactive. Verbal output was dramatically reduced. She exhibited waxy flexibility, stupor, mutism, posturing, rigidity, negativism, and grimacing. Video/EEG monitoring showed no evidence of ongoing seizure activity. She was treated with high-dose benzodiazepines for presumed catatonia, but the behavioral pattern did not resolve. Subsequently the patient underwent a full course of electroconvulsive therapy. Catatonia resolved over the ensuing 3 weeks. Following discharge from the hospital, the patient's global functioning returned to the premorbid level, and she has been seizure free for more than 4 years.