Objective. A case is reported of electroconvulsive therapy (ECT) in acute lethal catatonia.
Case. A male patient with acute lethal catatonia was re-hospitalised after an over a year 's remission with discontinuation of medication. In the differential diagnosis a CNS infection, acute poisoning with psychoactive substances, malignant neuroleptic syndrome, and malignant hyperthermia were taken into account. In view of the diagnostic doubts and the risk of severe complications following inappropriate treatment, it was decided to use ECT. ECT with bi-temporal localization of electrodes was performed in the operating room, and under the EEG and EKG control. After nine ECTs clozapine maintenance treatment, and preventive quetiapine administration, a two-year remission was attained. Quetiapine was substitutedfor clozapine due to a marked eosinophilia in the patient with a past history of allergy.
Commentary. ECT associated with succesive quetiapine treatment may be effective in acute lethal catatonia.