Treatment of Catatonia in Parkinson's Disease

Understanding Catatonia in Parkinson's Disease

• Catatonia can occur in Parkinson's disease (PD) patients, presenting as a severe manifestation that may be difficult to differentiate from worsening parkinsonian symptoms or negative symptoms 1

Recommended Treatment Approaches for Catatonia in PD

First-Line Treatments

• Lorazepam 1 mg subcutaneous or intravenous (lower doses in older or frail patients) is used as a first-line treatment for catatonia regardless of the underlying cause 2

Medications to Avoid in Catatonic PD Patients

• Stimulants like lisdexamfetamine (Vyvanse) are not indicated for catatonia in PD and could potentially exacerbate symptoms, as they may worsen psychotic symptoms that can accompany catatonia 3

Management Considerations for Parkinson's Disease

• Deep brain stimulation (DBS) targeting either the subthalamic nucleus or globus pallidus internus is effective for treating motor symptoms in appropriate PD candidates 4

Special Considerations

• Careful attention to protein intake timing is important in PD patients, as dietary protein can compete with levodopa absorption, and patients experiencing motor fluctuations may benefit from protein redistribution (low protein breakfast/lunch with normal protein dinner) 5
• Hypocalcemia should be monitored and treated as it can worsen movement disorders including catatonia-like presentations 6, 7