Lorazepam for post-operative pediatric cerebellar mutism syndrome: A case report.

This is one child, with no comparison group, so nothing here shows that lorazepam caused the improvement or that the same would happen in any other patient. He was taking gabapentin, bromocriptine and risperidone throughout the lorazepam trial and was receiving intensive inpatient rehabilitation at the same time, so the contribution of lorazepam cannot be separated from the others. The one-day withdrawal test was the authors' own attempt to tell drug effect from natural recovery, and a single day in a single child cannot settle that question. The comparison rests on one week in which the only recorded gain was a single WeeFIM unit, so the 40-unit rise is measured against very little. Scores by domain and over time are presented only in figures, which are not available here; the text gives totals. The authors themselves note lorazepam's sedative effects and dependency risk, and that its therapeutic effect was temporary, so any use would need to be short-term, monitored and individualised. After discharge, other drugs were tapered over the same months as lorazepam, so his later stability off medication cannot be credited to stopping any one drug.

The authors state they received no financial support for the research, authorship or publication of this article, and declared no potential conflicts of interest.

Do not read this as proof that lorazepam treats post-operative cerebellar mutism syndrome. It is one child who was also taking gabapentin, bromocriptine, risperidone and midazolam over the same period and was receiving intensive inpatient rehabilitation, so the improvement cannot be credited to any single one of them. The authors themselves call for studies to work out which patients respond and why.