Son with Tic/Catatonic like episodes
 

I have a 19 year old son who is on the Autism Spectrum, has OCD and Anxiety. He experiences episodes many times per day where his brain goes blank, his vision goes blurry or black, and he is often unable to move or continue the activity that he is performing until the episode is over. For example, the episodes can stop him mid-sentence and it can take him 5 minutes to complete a 10 word sentence. Sometimes he cannot physically move or complete a movement like jumping in the pool, getting out of his seat or brushing his teeth. He gets stuck with the toothbrush in mid-air and can't move forward with the task until the episode is over.

He has had multiple EEG's with no seizure activity noted. He is on a medication for mood stabilization which is also an anti-convulsant. He has seen a Tic Disorders specialist who feels that it may be tics that are a manifestation of his OCD. He does have a long history of treatment resistant OCD. Catatonia has been mentioned and we have tried benzos for this with no success.

He is regressing academically and socially. If anyone has any helpful information it would be greatly appreciated. Thank you!

Hi wendy,
Welcome to the NeuroTalk Support Groups! :Wave-Hello:

I'm really sorry to read what's going on for your son and I imagine it would be quite frightening and worrying for him and for you.

Tics vary a lot. People can have dystonic tics that tend to be a bit different from regular tics. They're usually slower and more sustained than regular motor tics, but they would not cause him to have the vision problems and what he describes as "brain going blank".

I'm not really understanding why the Tic Disorders Specialist would think these episodes are tic/ocd related, but then again I'm not a tic disorder specialist. I mean, if he was counting or ruminating over something or even attempting to suppress tics or "getting stuck", why would he have the vision problems - "blurry and black". Plus 10 minutes is an awfully long time to be in this type of state.

Has he had an AEEG? Ambulatory. Usually for 24hrs. I was just wondering about that because his other EEGs may not have been done when he was experiencing the episode.

Some medications as far as I know can cause catatonic symptoms in some people and people on Autism spectrum are often extremely sensitive to certain medications.

What medication is he on right now?

There's quite a bit in the medical literature regarding occurrance of catatonia in the Autism spectrum. It's not uncommon. Have you looked in PubMed at all or checked some of the national autism sites. There are references that might help.

Because he has a number of different diagnoses comorbid to autism, it might be making it more difficult for the doctors to sort out, but it certainly doesn't sound very good and the less time it takes to sort it out the better especially if he's suddenly regressing in his social and academic life.

So, sorry about the long post, but if he was my son (and I have adult son on autism spectrum who has comorbid conditions including Tics, obsessive compulsive behaviours, attention difficulties. NO seizures.) I'd...

Check into the medications and if they can actually cause catatonia
I'd check out the literature regarding catatonia and Autism
- catatonia and autism and stress (you mentioned anxiety)
I'd talk to the doctors about whether an AEEG would be worthwhile. (seizures not uncommon in autism)

I'd do it all as fast as possible.

Autism Speaks.
http://www.autismspeaks.org/blog/201...ated-catatonia
Does Our Teen Have Autism-related Catatonia?
Dr R Robinson
Jan 3, 2014


:hug: take care there

Great to meet you!!
 

Hi Lara,

Thank you for your reply. In addition to multiple standard EEG's, we have done 2 24-hour EEG's, both inpatient and outpatient, and neither showed any signs of seizure activity.

He currently takes Depakote, Onfi, Clonidine and Prevacid. I will do some research as to any possible connections with catatonia. Catatonia has been considered and he was put on Ativan but the dose may have not been high enough.

In the past 2 weeks he has also had episodes of falling asleep during the day which is totally unheard of for him. We saw his neurologist on Friday and she is considering the possibility of partial complex seizures and/or narcolepsy. She is consulting with my son's psychiatrist and a sleep specialist to decide on a plan.

It is all so confusing and complicated. My heart breaks for him and I need to figure this out. He is begging for someone to figure out what is happening to him and the doctors seem just as confused as me. It's so frustrating. Any further advice would be greatly appreciated.

Thank you,

Wendy

Wendy, there are a number of drug interaction checkers online.
Here's one of them
http://reference.medscape.com/drug-interactionchecker

I have to tell you though aside from everything else, my son was on a very low dose of Clonidine when he was quite young. It made him very sleepy during the day despite the dose being very low and despite it being given at night before bed. If the daytime tiredness is a new thing since the Clonidine was added, then perhaps the Clonidine dose or time of dose needs adjusting. Just a thought. Clonidine made my son very different. It wasn't good. [p.s. It's really important never to discontinue Clonidine without a taper]

Here's the link to the NeuroTalk Epilepsy Forum here in case you want to ask the users over there. They may be able to help in some way.

Also, from my limited understanding of seizures, a normal EEG doesn't necessarily mean that no seizures are occurring.

Don't forget there is also PubMed where you can search any specific keywords for information.

This article is quite old but there is a lot of information in it and there are a lot of references at the end which might be helpful.
The British Journal of Psychiatry (2000) 176: 357-362
Catatonia in autistic spectrum disorders
Wing and Shah 2000
http://bjp.rcpsych.org/content/176/4/357.long

"Most frequent manifestations of catatonia"
from Wing and Shah, 2000
http://bjp.rcpsych.org/content/176/4...expansion.html

Autism Speaks.
Does Our Teen Have Autism-related Catatonia?
http://www.autismspeaks.org/blog/201...ated-catatonia
Dr R Robinson
Jan 3, 2014

Edited to add:

I just had a thought and so am posting a small snippet from a book regarding
'Tic Mimickers' [Starts off with Dystonia vs Dystonic Tics and more...]
Tourette Syndrome, Volume 99
edited by John T. Walkup, Jonathan W. Mink, Peter James Hollenbeck
It's not new either, but has a good description.