A 6-Year-Old With Becker Muscular Dystrophy and Catatonia

Catatonia is often underrecognized and underdiagnosed, particularly in young children. Catatonia occurs secondary to a medical and/or psychiatric etiology. The diagnosis can be supported by validated rating scales, including the Pediatric Catatonia Rating Scale and/or response to a dose of a benzodiazepine, often lorazepam. We present the case of a 6-year-old boy with acute behavioral changes in speech, affect, awareness, and new odd behaviors, admitted to a quaternary care pediatric hospital for further assessment and work-up of symptoms consistent with catatonia. Laboratory testing was notable for previously undiagnosed Becker muscular dystrophy (BMD), although otherwise unremarkable. He received many medication treatments for catatonia, including escalating doses of lorazepam and augmentation with memantine, zolpidem, quetiapine, and ultimately clozapine, without adequate symptom improvement and with side effects including significant weight gain. Neither behavioral interventions nor empirical treatment of presumed seronegative autoimmune encephalitis with intravenous immunoglobulin and methylprednisolone conferred benefit. He ultimately received electroconvulsive therapy, with significant and relatively rapid improvement occurring over 2 weeks after a 4-month hospitalization. This case highlights the importance of the identification of catatonia to guide evidence-based treatment and the value of timely access to electroconvulsive therapy for pediatric patients. While the etiology of his catatonia remains undetermined, his diagnosis of BMD could play a role and further supports the importance of a comprehensive medical work-up.