Ep 221 Electroconvulsive Therapy Part 2: A current conversation

A five-year-old girl arrived at the hospital with seizures and was diagnosed with epilepsy. When she returned with unusual movements and mutism—a state of complete unresponsiveness—doctors diagnosed her with catatonia. Further testing revealed anti-NMDA receptor encephalitis, an autoimmune condition where the body attacks its own brain tissue. For nine months, she received immunotherapy and high-dose benzodiazepines. She remained catatonic: unable to speak, dress, or feed herself, reliant on a feeding tube and total nursing care. Her medical team, having exhausted standard treatments, began discussing electroconvulsive therapy (ECT).

ECT is a gold-standard treatment for catatonia, with very high response rates regardless of the underlying cause. But treating a five-year-old was unusual—catatonia in young children has been historically underrecognized. With her parents' consent, she was transferred to Dr. Leonardo Lopez's hospital. After eight weeks of ECT, her catatonia resolved entirely. She began speaking, walking, playing games, and drawing. By Thanksgiving, she was eating a full meal with her family. As Dr. Lopez, vice chair for inpatient services and associate professor of clinical psychiatry at Weill Cornell Medical College, describes it, this case is "a testament to the power of the treatment, particularly for catatonia, and a reminder that we do have this treatment ava