thiopental and Atrophy

We describe a case of catatonia in a 51-year-old man in whom the catatonic symptoms could not be distinguished from symptoms of frontotemporal dementia (FTD) until they were resolved with electroconvulsive therapy (ECT). When it is difficult to distinguish between catatonia and FTD in patients with frontal dysfunction associated with frontal lobe atrophy, we believe that sequential administration of benzodiazepines and ECT is important for therapeutic diagnosis because the risk of missing a diagnosis of catatonia outweighs the risks associated with administration of benzodiazepines and/or ECT.

Topics: Anti-Arrhythmia Agents; Anticonvulsants; Antimanic Agents; Atrophy; Atropine; Bipolar Disorder; Catatonia; Diagnosis, Differential; Electroconvulsive Therapy; Follow-Up Studies; Frontal Lobe; Frontotemporal Dementia; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Neuromuscular Depolarizing Agents; Succinylcholine; Thiopental; Treatment Outcome; Valproic Acid

To delineate a catastrophic childhood epileptic syndrome of unknown cause presenting with persistent intractable multifocal status.. Case note review.. Six children aged 5 months to 6 years presented with focal seizures that progressed within days to intractable multifocal seizures with or without secondary generalisation, which recurred every few minutes and persisted for weeks. One developed impaired consciousness shortly before seizures started. The two younger children showed mild developmental delay before onset but the others were normal. The seizures were unresponsive to all conventional anticonvulsants, steroids or pyridoxine and could only be controlled with doses of thiopentone sufficient to cause electrical suppression. MRI scans were initially normal but later showed focal cortical swelling followed by generalised atrophy. Two developed hepatomegaly, with a normal liver biopsy in one and steatosis in the other. No cause has been found even after neuropathological investigation. Three have died, two within 3 months of onset, while the three survivors have very severe neurological impairment and continued seizures.. The similarity of the clinical features suggests that this is a consistent clinical syndrome.

Topics: Anesthetics, Intravenous; Anticonvulsants; Atrophy; Brain; Child; Child, Preschool; Disease Progression; Electroencephalography; Epilepsy; Female; Hepatomegaly; Humans; Hypnotics and Sedatives; Infant; Liver; Magnetic Resonance Imaging; Male; Seizures; Thiopental