Some people with autism also have catatonia, and electroconvulsive therapy may be helpful in some of those cases.
Catatonia is a brain condition with symptoms where the person repeats words (his own or the words of others), repeats behaviors, and has a grimace look on his face. Catatonia symptoms are common in some people with autism. Catatonia can be severe for some people, resulting in loss of movement, reduced speech, or stupor. More mild symptoms of catatonia include freezing during actions, slow movement and/or speech. Electroconvulsive therapy (ECT) uses a mild electric shock that is given to specific places in the brain while the patient is under anesthesia (unconscious). The helpful effect of ECT comes from the seizures that are triggered in the brain by the electrical current. The electrical current happens to be the most reliable way to induce seizures in the brain. How seizures improve catatonia is unknown. The authors said that ECT therapy has been helpful for some people who have both autism and catatonia.
Autism Therapy: anesthesia
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- Journal of ECT, by Dhossche, DM, Reti IM, and Wachtel LE, published in 2009, summarized Oct 19, 2009
- European Child and Adolescent Psychiatry, by Wachtel, LE, Contrucci_Kuhn SA, Griffin M., Thompson A., Dhossche DM, and Reti IM, published in 2009, summarized Jul 15, 2009
Electroconvulsive therapy reduced severe self-injury behavior in a boy with autism, allowing him to attend school.
This case study reported electroconvulsive therapy (ECT) for an 8-year-old boy with autism, mental retardation, mood swings, and extreme self-injury behavior. He was trying to hurt himself an average of 109 times per hour. Applied behavior analysis (ABA) therapy and drug therapy did not work. He had to stay in the hospital. He wore arm restraints with metal strips to limit where his arms could reach. And he wore full-body protective padding so he wouldn’t hurt himself. He was treated with ECT 3 times per week for 5 weeks. ECT therapy is a medical procedure that uses a brief electric current to the brain in a closely-monitored medical setting under full anesthesia. Doctors also use neuromuscular blockade (temporary full relaxation of muscles) during the procedure. After 5 weeks of ECT, he no longer needed restraints and protective padding. This child was able to return home after 2 years in a hospital, attend school and learn for the first time, and also participate in meaningful family life. The authors said this was the first report of successful ECT for self-injury behavior. They recommended that doctors consider ECT when other therapies don’t work.
- Journal of Anesthesia, by Shah, S., Shah S., Apuya J., Gopalakrishnan S., and Martin T., published in 2009, summarized Apr 20, 2009
The drugs ketamine and midazolam may be used to prepare children with severe autism for surgery.
It can be hard to manage a patient with autism who has to have surgery. Sometimes doctors must use restraints and forced shots and this can be hard on the patient and the family. There are few studies on drugs that can be used to treat patients with autism to make it easier for them to go into surgery. This case report describes a patient with severe autism who needed general anesthesia for tooth surgery. The authors found that placing the ketamine and midazolam in the soft drink Dr. Pepper made it easy for the patient to take it.
- J Oral Maxillofac Surg, by Lalwani, K., Kitchin J., and Lax P., published in 2007, summarized Apr 16, 2007
Office-based sedation seems safe for children with autism who need dental work.
The pediatric sedation service model allows children to be sedated for dental surgery and dental work wherever dentists practice. The authors of this study looked at the best way to sedate children with special needs who needed dental surgery; 38% of the children in their study had autism. They found that the pediatric sedation service model was as safe as general anesthesia in an operating room. They found that one of the best ways to make sure that children are safe is to be sure that children are screened for sleep apnea syndrome (poor breathing while asleep). They also note that sedation is safest when done with a doctor present.
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