Electroconvulsive Therapy in a Patient With Down Syndrome Regression Disorder and Inspire Device

Electroconvulsive therapy (ECT) remains one of the most effective treatments for catatonia, but its use in patients with implantable airway stimulation devices, such as the Inspire device for obstructive sleep apnea (OSA), is very rare, with only 2 prior cases described in the literature: one for major depressive disorder and one without a specified indication. There is no practical guidance for safely administering ECT with an implanted Inspire device. We describe a 32-year-old male with autism spectrum disorder (ASD), epilepsy, and OSA treated with an Inspire device who developed Down syndrome regression disorder (DSRD) and catatonia. DSRD is characterized by the acute loss of previously acquired skills in language, social engagement, and executive functioning. Standard medication approaches were either poorly tolerated or ineffective, leaving ECT as the best remaining option. Following the Inspire manufacturer's safety recommendations, which included turning the device off during each session and carefully positioning electrodes, the patient underwent 30 ECT treatments over 11 months. Gradually, his speech and ability to manage daily activities improved, the aggressive outbursts stopped, and no serious complications occurred. Our experience shows that, with thoughtful planning and precautions, ECT can be delivered safely and effectively for catatonia in DSRD with an implanted Inspire device. As more patients receive implantable airway stimulators, awareness of how to manage these cases will become increasingly important.