Lamotrigine as a preventive agent against recurrent catatonia in adult-onset Niemann-Pick Type-C disease: a case report

Niemann-Pick Type-C (NPC) disease, an autosomal recessive lysosomal storage disorder, is associated with a spectrum of neuropsychiatric manifestations, including catatonia, which may not respond to conventional treatment. Here we report the case of a patient with adult-type NPC disease who developed catatonia and experienced recurrent catatonic episodes after the administration of antipsychotics required to treat active psychotic symptoms. Despite unsuccessful attempts with lorazepam, clozapine, and memantine to treat the catatonic symptoms, the patient showed improvement with electroconvulsive therapy (ECT). Catatonia recurred shortly after ECT discontinuation and improved with resuming ECT and adding lorazepam. However, catatonia recurred when the ECT frequency was reduced. We were able to resolve the catatonia with a combination of ECT and lorazepam. However, when we reduced the frequency of ECT sessions, the catatonia recurred despite continued lorazepam treatment. Remarkably, the addition of lamotrigine to the patient's treatment resulted in complete remission with no further recurrence of catatonia for 8 months. Our case highlights lamotrigine's mood-stabilizing effect and possible anti-NMDA effect in treating and preventing recurrent catatonia.