背景:脑瘫患者,一组运动障碍与运动,通信,和可以模仿紧张性体征的行为特征,可以从改善合并症的检测和治疗的努力中受益。鉴于脑瘫经常与诸如自闭症谱系障碍等卡顿多症相关的疾病同时发生,癫痫,智力残疾,情绪和精神障碍,这一人群中紧张症的终生患病率可能很高。
目的:系统回顾脑性瘫痪患者的神经强直和神经阻滞剂恶性综合征(NMS)相关情况的文献。同时又出现了另外两例紧张症。
方法:我们将术语“脑瘫”与“catatoni*”结合使用,卡顿的相关术语,和“抗精神病药恶性综合征”查询OVIDMedline(1948年-2022年11月28日),PsycINFO,护理累积指数,和联合健康文献,和Embase适用的病例报告。还手动搜索了抗精神病药恶性综合征信息服务数据库。
结果:除了我们的两份卡顿尼亚报告外,我们在脑瘫患者中发现了十例卡通症,以及八份NMS报告。两种情况的患者反应良好,有时很快,治疗。值得注意的是,在接受电惊厥治疗(ECT)的5例紧张症和脑瘫患者中,两名患者在治疗后出现复发性自限热疗.我们还发现了几例巴氯芬戒断的病例,由于癫痫发作的风险可能危及生命,在鞘内注射巴氯芬泵发生故障的脑瘫患者中,表现出NMS样特征,用于痉挛管理。
结论:考虑到脑瘫患者与紧张症相关的常见合并症,以及可以诱导NMS的药物的常规治疗,如甲氧氯普胺和抗胆碱能药物,在脑瘫患者人群中,紧张症和NMS可能被低估,尽管是高度可治疗的。脑瘫患者的卡通症可能被低估可能是由于两种情况与脑瘫之间重叠特征的错误归因。临床医生在使用ECT治疗卡顿和脑瘫患者时,应意识到可能反复出现的自限性发热,同时在脑瘫患者中遇到NMS样特征时,也要警惕鞘内注射巴氯芬的戒断。
Patients with cerebral palsy, a group of movement disorders with motor, and possibly communication and behavioral features that mimic catatonic signs, may benefit from efforts to improve the detection and treatment of comorbid catatonia. Given that cerebral palsy frequently co-occurs with conditions associated with catatonia, such as autism spectrum disorder, epilepsy, intellectual disability, and mood and psychotic disorders, lifetime prevalence of catatonia in this population may be high.
This study aimed to systematically
review the literature on catatonia and the related condition of neuroleptic malignant syndrome (NMS) in patients with cerebral palsy while presenting 2 additional cases of catatonia.
We used the terms \"cerebral palsy\" in combination with \"catatoni∗,\" related terms for catatonia, and \"neuroleptic malignant syndrome\" to query Ovid MEDLINE (1948 to November 28, 2022), PsycINFO, Cumulative Index to Nursing, and Allied Health Literature, and Embase for applicable case reports. The Neuroleptic Malignant Syndrome Information Service database was also manually searched.
In addition to our 2 catatonia reports, we identified 10 reports of catatonia in patients with cerebral palsy, as well as 8 reports of NMS. Patients with both conditions responded well, and sometimes rapidly, to treatment. Notably, of the 5 patients with catatonia and cerebral palsy who received electroconvulsive therapy, 2 developed recurrent self-limited hyperthermia posttreatment. We also identified several cases of baclofen withdrawal, which can be life threatening because of seizure risk, presenting with NMS-like features in patients with cerebral palsy who had malfunctioning intrathecal baclofen pumps for spasticity management.
Given frequent comorbidity of conditions associated with catatonia in patients with cerebral palsy, as well as routine treatment with medications that can induce NMS, such as metoclopramide and anticholinergics, catatonia and NMS may be underreported in the cerebral palsy patient population, despite being highly treatable. Possible underdiagnosis of catatonia in patients with cerebral palsy may be because of misattribution of overlapping features between the 2 conditions to cerebral palsy. Clinicians should be aware of possible recurrent self-limited fever when using electroconvulsive therapy to treat patients with catatonia and cerebral palsy while also being vigilant for intrathecal baclofen withdrawal when encountering NMS-like features in patients with cerebral palsy.