Tardive seizure: a case report

Tardive seizure after electroconvulsive therapy: Prevalence and associated factors

INTRODUCTION

Tardive seizure refers to a spontaneous seizure, which occurs after electroconvulsive therapy (ECT). It is a rare and poorly understood phenomenon that can lead to other serious consequences such as status epilepticus. Risk factors may be associated, and its management is by no means consensual. However, tardive seizure remains little explored in the absence of feedback and data sharing. The purpose of this study was to report the prevalence of late-onset seizures following ECT during the acute phase of treatment at the stimulation unit of Razi Hospital during its seven years of activity and to identify variables associated with this adverse event.

METHODS

This is a descriptive and retrospective study that was carried out at the ECT unit of Razi Hospital, Tunisia, based on the medical records of patients treated with ECT between December 2015 and September 2023. Every recorded ECT session during the initial course of treatment with available EEG tracings was included in the study. Maintenance ECT sessions, undocumented sessions, those without clinical observations, and/or those without EEG tracings were all excluded. A tardive seizure was retained according to criteria that included both recorded motor manifestations such as "motor jerks" or "generalized tonic-clonic seizures" which began spontaneously after ECT and the resumption of a state of consciousness concurrent with an equivocal EEG tracing.

RESULTS

A total of 162 patients received at least one course of ECT during the research period. Ultimately, we included 1931 well documented sessions that were completed for 157 patients in all. Of the 157 patients, seven had experienced at least one late seizure after receiving ECT, accounting for 4.45% of patients. Among the 1931 sessions, 11 late seizures were noted. The prevalence of tardive seizures in our series was 0.57%. Several factors have been associated to the onset of a tardive seizure, including being a male, the presence of a neurological lesion, treatment that lowers the epileptogenic threshold, anesthesia with etomidate, stimulation charge near seizure threshold or maximum electrical load, prolonged induced seizure, and poor post-ictal suppression on the induced seizure tracing.

CONCLUSION

Despite the dearth of information, tardive seizure following ECT is considered to be a rare event. Risk factor management would be the first action to be taken to prevent such an event.

Tardive Seizures After Electroconvulsive Therapy

OBJECTIVES

Seizures that occur spontaneously after termination of an electroconvulsive therapy (ECT) seizure are termed tardive seizures. They are thought to be a rare complication of ECT, influenced by risk factors that affect seizure threshold. However, there has been limited review of tardive seizures with modified ECT. We aimed to review the literature to provide clinical guidance for the use of ECT after tardive seizures.

METHODS

PubMed, EMBASE, PsycInfo, and CINAHL databases were searched from inception to May 2021 to identify cases of modified ECT, with evidence of a seizure occurring within 7 days of a terminated ECT seizure. Data for demographic, medical, pharmacological, anesthetic, and ECT variables as well as management strategies were collected.

RESULTS

There have been 39 episodes of modified ECT-related tardive seizures published over a period of 40 years. In 97.4% of cases, there was at least 1 identified potential risk factor for seizures, including use of a seizure-lowering medication and/or preexisting neurological injury. Major complications were uncommon (<15% of cases); however, 1 fetal death and 1 subsequent suicide were reported. No case was diagnosed with epilepsy, although around 20% continued on antiepileptic medications. More than half of the included patients were retrialed on ECT, with only 15% developing further tardive seizures.

CONCLUSIONS

Seizures that occurred spontaneously after the termination of an ECT seizure are a rare complication of modified ECT. Recommencing ECT after a tardive seizure may occur after review of modifiable seizure risk factors and with consideration of antiepileptic medication and extended post-ECT monitoring.

Tardive seizure and antibiotics: case reports and review of the literature

Tardive seizure is a serious adverse reaction of electroconvulsive therapy (ECT). However, it was rarely reported in ECT sessions for psychiatric patients who needed concurrent antibiotic treatments. We present 2 cases of patients with schizophrenia who manifested a catatonic syndrome and were indicated for ECT, along with antibiotic therapies for infectious diseases with piperacillin and cefotiam, respectively. The beta-lactam antibiotics are reported to induce convulsions caused by the suppression of inhibitory GABAergic functions. In addition, there is a report on prolonged ECT seizure related to ciprofloxacin, which has an epileptogenic property with a similar action to beta-lactam antibiotics. Thus, tardive seizures in our cases are thought to be related to piperacillin and cefotiam.