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Shin HR, Kim M, Park KI. Electroconvulsive therapy and seizure: a double-edged sword? ENCEPHALITIS 2023; 3:103-108. [PMID: 37621189 PMCID: PMC10598284 DOI: 10.47936/encephalitis.2023.00059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 06/15/2023] [Accepted: 06/16/2023] [Indexed: 08/26/2023] Open
Abstract
Electroconvulsive therapy (ECT) is a widely used therapeutic option of drug-refractory psychiatric disorders. ECT treats psychiatric symptoms by inducing brief controlled seizures through electrical stimulation, but ECT does not generally cause prolonged seizures or epilepsy. However, several studies have reported cases of prolonged seizures after ECT. This review aimed to determine the mechanism of epileptogenesis with neurobiological changes after ECT. Contrary to epileptogenesis by ECT, several cases have reported that ECT was successfully applied for treatment of refractory status epilepticus. In addition, ECT might be applied to hyperkinetic movement and psychiatric symptoms of encephalitis. We also investigated the anticonvulsant mechanism of ECT and how it controls encephalitis symptoms.
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Affiliation(s)
- Hye-Rim Shin
- Department of Neurology, Dankook University Hospital, Cheonan, Korea
| | - Minah Kim
- Department of Neuropsychiatry, Seoul National University Hospital, Seoul, Korea
| | - Kyung-Il Park
- Department of Neurology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
- Department of Neurology, Seoul National University Hospital Healthcare System Gangnam Center, Seoul, Korea
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2
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Warren N, Eyre-Watt B, Pearson E, O'Gorman C, Watson E, Lie D, Siskind D. Tardive Seizures After Electroconvulsive Therapy. J ECT 2022; 38:95-102. [PMID: 35093969 DOI: 10.1097/yct.0000000000000821] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
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.
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Affiliation(s)
| | | | | | | | - Emily Watson
- Department of Neurology, Princess Alexandra Hospital
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Trifu S, Sevcenco A, Stănescu M, Drăgoi AM, Cristea MB. Efficacy of electroconvulsive therapy as a potential first-choice treatment in treatment-resistant depression (Review). Exp Ther Med 2021; 22:1281. [PMID: 34630636 PMCID: PMC8461517 DOI: 10.3892/etm.2021.10716] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 07/27/2021] [Indexed: 12/12/2022] Open
Abstract
Electroconvulsive therapy (ECT) is a technique that has been used since 1938 to treat several psychiatric disorders as a replacement for chemically induced seizures. Despite its history of stigma, controversy and low accessibility, ECT is found to be beneficial and efficient in severe cases of depression where medication fails to bring results. Titration tables developed over time, based on evidenced-based medicine, have made this treatment technique safe and, in some cases, the first choice of treatment. The aim of the review was to summarize the research conducted on the efficacy of ECT on major depressive disorder and variables studied such as technique, comorbidities and medication as well as the effects and outcomes of this procedure. At the same time, the application and correlations with other psychiatric and neurological disorders, including catatonia, agitation and aggression in individuals with dementia, schizophrenia, and epilepsy were assessed. There are no statistically demonstrated effects due to the fact that a small number of moderate-quality studies have been published; however, the combination of ECT technique with standard medication and care, can improve patient outcome. Furthermore, with regard to ECT, widespread and robust volume changes in both cortical and subcortical regions have been shown. Antidepressant response and volumetric increases appear to be limited by the specific neuroplasticity threshold of each patient.
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Affiliation(s)
- Simona Trifu
- Department of Clinical Neurosciences, 'Carol Davila' University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Anca Sevcenco
- Faculty of Psychology and Educational Sciences, University of Bucharest, 050663 Bucharest, Romania
| | - Monica Stănescu
- Faculty of Psychology and Educational Sciences, University of Bucharest, 050663 Bucharest, Romania
| | - Ana Miruna Drăgoi
- Department of Psychiatry, 'Prof. Dr. Alex. Obregia' Clinical Hospital of Psychiatry, 041914 Bucharest, Romania
| | - Mihai Bogdan Cristea
- Department of Morphological Sciences, 'Carol Davila' University of Medicine and Pharmacy, 020021 Bucharest, Romania
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Bansal S, Surve RM, Dayananda R. Challenges during Electroconvulsive Therapy—A Review. JOURNAL OF NEUROANAESTHESIOLOGY AND CRITICAL CARE 2021. [DOI: 10.1055/s-0041-1731627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
AbstractElectroconvulsive therapy (ECT) is one of the most successful treatment techniques employed in psychiatric practice. ECT is usually administered as a last resort to a patient who fails to respond to medical management or on an urgent basis as a life-saving procedure when immediate response is desired. It is performed under general anesthesia and is often associated with autonomic changes. All attempts should be made to minimize the resulting hemodynamic disturbances in all the patients using various pharmacological methods. Anesthesiologists providing anesthesia for ECT frequently encounter patients with diverse risk factors. Concurrent cardiovascular, neurological, respiratory, and endocrine disorders may require modification of anesthetic technique. It is ideal to optimize patients before ECT. In this review, the authors discuss the optimization, management, and modification of anesthesia care for patients with various cardiac, neurological, respiratory, and endocrine disorders presenting for ECT to improve the safety of the procedure. It is not infrequent that an anesthesiologist also plays an important role in inducing a seizure. Proconvulsants such as caffeine, adjuvants like opioids, hyperventilation, and appropriate choice of anesthetic agent for induction such as etomidate or ketamine can help. The use of BIS monitoring to guide the timing of electric stimulation is also elaborated in this review.
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Affiliation(s)
- Sonia Bansal
- Department of Neuroanaesthesia and Neurocritical Care, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Rohini M. Surve
- Department of Neuroanaesthesia and Neurocritical Care, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Rajeev Dayananda
- Department of Anaesthesia, BGS Gleneagles Global Hospitals, Kengeri, Bengaluru, Karnataka, India
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Lomas M, Rickard V, Milton F, Savage S, Weir A, Zeman A. Electroconvulsive therapy related autobiographical amnesia: a review and case report. Cogn Neuropsychiatry 2021; 26:107-121. [PMID: 33467984 DOI: 10.1080/13546805.2021.1871889] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Introduction: While short-term cognitive impairment following electroconvulsive therapy (ECT) is well described and acknowledged, the relationship between ECT and persistent memory impairment, particularly of autobiographical memory, has been controversial. Methods: We describe the case of a 70-year-old consultant neurophysiologist, AW, who developed prominent, selective autobiographical memory loss following two courses of ECT for treatment-resistant depression. Results: His performance on standard measures of IQ, semantic and episodic memory, executive function and mood was normal, while he performed significantly below controls on measures of episodic autobiographical memory. Conclusions: Explanations in terms of mood-related memory loss and somatoform disorder appear unlikely. We relate AW's autobiographical memory impairment, following his ECT, to reports of similar autobiographical memory impairment occurring in the context of epilepsy, and emphasise the importance of using sensitive approaches to AbM assessment.
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Affiliation(s)
- Matthew Lomas
- College of Medicine and Health, College House, University of Exeter, Exeter, UK
| | - Victoria Rickard
- College of Medicine and Health, College House, University of Exeter, Exeter, UK
| | - Fraser Milton
- School of Psychology, College of Life and Environmental Sciences, Washington Singer, University of Exeter, Exeter, UK
| | - Sharon Savage
- School of Psychology, College of Life and Environmental Sciences, Washington Singer, University of Exeter, Exeter, UK
| | - Andrew Weir
- Institute of Neurological Sciences, Langlands Drive, University of Glasgow, Glasgow, UK
| | - Adam Zeman
- College of Medicine and Health, College House, University of Exeter, Exeter, UK
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Willeford A, Trumm N, Bisanz B, Parathasarathy V, Clark RF. Methohexital-Induced Seizure in a Patient Undergoing Conscious Sedation. J Emerg Med 2020; 59:224-226. [PMID: 32565170 DOI: 10.1016/j.jemermed.2020.05.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 05/04/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Methohexital is a short-acting barbiturate used for procedural sedation in the emergency department (ED). As with other sedatives, adverse effects with methohexital include excess sedation and hypotension, but this agent can also lower the seizure threshold. We report a patient who developed a generalized seizure after administration of methohexital. CASE REPORT A 60-year-old man presented to the ED by ambulance with chest pain and shortness of breath. Paramedics had administered adenosine for supraventricular tachycardia without conversion before arrival to the ED. He had no history of seizures. His initial vital signs in the ED included heart rate of 189 beats/min with a supraventricular rhythm, blood pressure 137/108 mm Hg, respiration 22 breaths/min, and oxygen saturation of 98% on room air. It was decided to attempt synchronized electrical cardioversion, and methohexital 1 mg/kg (120 mg) was administered over 2 min for moderate sedation. Within 15 s of methohexital administration, the patient developed a generalized seizure that lasted for 90 s. After seizure termination, he was successfully cardioverted, returned to his previous baseline level of consciousness within 20 min, and discharged without further problems with a follow-up referral to neurology. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Methohexital is a short-acting barbiturate used for moderate sedation. Its adverse effects are unique in that it can lower the seizure threshold in some patients. Alternative agents for sedation should be considered in individuals with possible seizure disorders.
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Affiliation(s)
- Andrew Willeford
- Department of Pharmacy, UC San Diego Medical Center, San Diego, California
| | - Nicholas Trumm
- Department of Pharmacy, UC San Diego Medical Center, San Diego, California
| | - Bryan Bisanz
- Department of Emergency Medicine, UC San Diego Medical Center, San Diego, California
| | - Vishnu Parathasarathy
- Department of Emergency Medicine, UC San Diego Medical Center, San Diego, California
| | - Richard F Clark
- Department of Emergency Medicine, UC San Diego Medical Center, San Diego, California; Division of Medical Toxicology, UC San Diego Medical Center, San Diego, California
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Moshé SL, Galanopoulou AS. Commentary on Schotte et al. "Development of temporal lobe epilepsy during maintenance electroconvulsive therapy: A case of human kindling?". Epilepsia Open 2019; 4:206-209. [PMID: 30868133 PMCID: PMC6398154 DOI: 10.1002/epi4.12296] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2018] [Accepted: 10/18/2018] [Indexed: 11/06/2022] Open
Affiliation(s)
- Solomon L. Moshé
- Saul R. Korey Department of NeurologyIsabelle Rapin Division of Child NeurologyDominick P. Purpura Department of NeuroscienceLaboratory of Developmental EpilepsyAlbert Einstein College of MedicineEinstein/Montefiore Epilepsy CenterMontefiore Medical CenterBronxNew York
- Department of PediatricsAlbert Einstein College of MedicineEinstein/Montefiore Epilepsy CenterMontefiore Medical CenterBronxNew York
| | - Aristea S. Galanopoulou
- Saul R. Korey Department of NeurologyIsabelle Rapin Division of Child NeurologyDominick P. Purpura Department of NeuroscienceLaboratory of Developmental EpilepsyAlbert Einstein College of MedicineEinstein/Montefiore Epilepsy CenterMontefiore Medical CenterBronxNew York
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Schotte C, Cleeren E, Goffin K, Hunyadi B, Buggenhout S, Van Laere K, Van Paesschen W. Development of temporal lobe epilepsy during maintenance electroconvulsive therapy: A case of human kindling? Epilepsia Open 2019; 4:200-205. [PMID: 30868132 PMCID: PMC6398093 DOI: 10.1002/epi4.12294] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2018] [Revised: 10/05/2018] [Accepted: 10/09/2018] [Indexed: 11/09/2022] Open
Abstract
We describe a patient with new-onset temporal lobe epilepsy during prolonged maintenance electroconvulsive therapy. We suggest a possible causal relationship with maintenance electroconvulsive therapy through electrical kindling of the temporal lobe.
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Affiliation(s)
| | - Evy Cleeren
- Department of NeurologyUniversity Hospitals LeuvenLeuvenBelgium
- Laboratory for Epilepsy ResearchKU LeuvenLeuvenBelgium
| | - Karolien Goffin
- Department of Nuclear MedicineUniversity Hospital LeuvenLeuvenBelgium
- Department of Imaging and PathologyNuclear Medicine and Molecular ImagingKU LeuvenLeuvenBelgium
| | - Borbala Hunyadi
- Faculty of EEMCSTU DelftDelftThe Netherlands
- Department of Electrical Engineering (ESAT)STADIUS Center for Dynamical Systems, Signal Processing and Data AnalyticsKU LeuvenLeuvenBelgium
| | - Satya Buggenhout
- Department of PsychiatryUniversity Psychiatric Centre KU LeuvenKortenbergBelgium
| | - Koen Van Laere
- Department of Nuclear MedicineUniversity Hospital LeuvenLeuvenBelgium
- Department of Imaging and PathologyNuclear Medicine and Molecular ImagingKU LeuvenLeuvenBelgium
| | - Wim Van Paesschen
- Department of NeurologyUniversity Hospitals LeuvenLeuvenBelgium
- Laboratory for Epilepsy ResearchKU LeuvenLeuvenBelgium
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Affiliation(s)
- Ali A Asadi-Pooya
- Jefferson Comprehensive Epilepsy Center, Department of Neurology, Thomas Jefferson University, Philadelphia, Pennsylvania, U.S.A.,Neurosciences Research Center, Shiraz Medical School, Shiraz University of Medical Sciences, Shiraz, Iran
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Archer JS, Bryson A, Gardner H, Wilson I, Rolfe T. Response: Can ECT cause “kindling” in the human brain ? Epilepsia 2017; 58:177-178. [DOI: 10.1111/epi.13641] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- John S. Archer
- Department of Neurology; Austin Hospital; Heidelberg Victoria Australia
- Department of Medicine; Austin Health; The University of Melbourne; Heidelberg Victoria Australia
| | - Alexander Bryson
- Department of Neurology; Austin Hospital; Heidelberg Victoria Australia
| | - Helen Gardner
- Department of Neurology; Austin Hospital; Heidelberg Victoria Australia
| | - Ian Wilson
- Department of Neurology; Cairns Hospital; Cairns Queensland Australia
| | - Tim Rolfe
- Department of Psychiatry; Austin Health; Heidelberg Victoria Australia
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