Bridging the Cartesian Divide Between Organic and Functional Catatonia: A Case Report

Abstract

Electroconvulsive therapy (ECT) is a well-established and highly effective treatment for catatonia. Historically, a history of intracranial surgery was regarded as a relative contraindication. This was because of concerns about increased intracranial pressure and postoperative vulnerability. However, emerging evidence supports the safe use of ECT in patients with previous neurosurgical procedures when multidisciplinary team discussion confirms anatomical stability. We describe a woman in her late fifties who developed profound catatonia nearly one year after undergoing left pterional craniotomy and meningioma resection. She presented with mutism, immobility, and refusal to eat or drink. Investigations excluded tumor recurrence, infection, metabolic disturbances, and autoimmune encephalitis. Despite treatment with high-dose lorazepam, titrated up to 2 mg four times daily, her symptoms persisted. Following multidisciplinary review, including neurosurgical confirmation of stable postoperative anatomy, normal intracranial pressure and absence of mass effect, modified bilateral ECT was initiated. The patient tolerated treatment well with no complications and demonstrated gradual, sustained improvement across motor, cognitive, and affective domains after approximately twenty-six sessions. Lithium was subsequently introduced to support mood stabilization and functional recovery, with plans to taper ECT once lithium efficacy was established. She continues to receive ECT as part of a multidisciplinary neurorehabilitation program with improvements in communication and social engagement. This case illustrates that ECT is a viable, safe, and effective intervention for catatonia even in patients with a history of intracranial surgery. It also highlights ECT's role not only as a psychiatric treatment but as a neuromodulatory therapy capable of restoring motor and volitional function following structural brain injury. The case thereby bridges the traditional divide between organic and functional paradigms of neuropsychiatric conditions.

Keywords: catatonia; electroconvulsive therapy; functional recovery; intracranial surgery; lithium maintenance therapy; meningioma resection; multidisciplinary management; neurorehabilitation; organic brain injury; postoperative neuropsychiatry.