Zilles David
Department of Psychiatry and Psychotherapy, University Medical Center Göttingen, Göttingen, Germany.
Front Psychiatry. 2019 Feb 27;10:86. doi: 10.3389/fpsyt.2019.00086. eCollection 2019.
Catatonia is a syndrome comprising psychomotor, behavioral, and autonomous symptoms which may occur in the context of severe schizophrenic, affective, and other mental disorders or medical conditions. Treatment options include high dose benzodiazepines (lorazepam) and electroconvulsive therapy (ECT) with some evidence for the effectiveness of glutamate antagonists. However, due to a lack of randomized controlled studies in this severely ill population, evidence base is weak. On occasion of the case of a patient with treatment resistant catatonia in schizoaffective disorder, we developed the hypothesis of vagus nerve stimulation (VNS) being a potential therapy for treatment resistant catatonia. Based on a selective literature search, we found a remarkable overlap of the pathophysiology of catatonia on the one hand and the putative mechanisms of action of VNS on the other hand in several domains: functional brain imaging, involved neurotransmitter systems, clinical, and theoretical. We thus decided to use VNS as a single subject clinical trial. During the 1-year-follow-up, we observed a fluctuating, but ultimately marked improvement of both catatonic symptoms and general psychopathology. We assume there is a sufficient hypothetical corroboration for the potential effectiveness of VNS as a long-term treatment in predominantly catatonic syndromes. This hypothesis could be tested in proof-of-concept clinical trials.
紧张症是一种综合征，包括精神运动、行为和自主神经症状，可能发生在严重的精神分裂症、情感性精神障碍和其他精神障碍或躯体疾病的背景下。治疗选择包括高剂量苯二氮䓬类药物（劳拉西泮）和电休克治疗（ECT），有一些证据表明谷氨酸拮抗剂有效。然而，由于在这一重症人群中缺乏随机对照研究，证据基础薄弱。在一名患有分裂情感性障碍且对治疗抵抗的紧张症患者的病例中，我们提出了迷走神经刺激（VNS）可能是治疗抵抗性紧张症的一种潜在疗法的假设。基于选择性文献检索，我们发现紧张症的病理生理学与VNS的假定作用机制在几个领域存在显著重叠：功能性脑成像、涉及的神经递质系统、临床和理论方面。因此，我们决定将VNS作为一项单病例临床试验。在1年的随访期间，我们观察到紧张症症状和一般精神病理学症状都有波动，但最终有显著改善。我们认为，对于VNS作为主要紧张症综合征的长期治疗的潜在有效性，有足够的假设性证据支持。这一假设可在概念验证临床试验中进行检验。
