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Uncommon but serious complications associated with electroconvulsive therapy: Recognition and management for the clinician

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Abstract

Electroconvulsive therapy (ECT) is a safe and effective treatment for severe mood disorders. Rarely there can be serious complications, such as postictal agitation, cardiovascular compromise, prolonged seizures, and status epilepticus, all of which are important for the clinician to recognize and treat. Postictal agitation can be severe, requiring emergent intervention and subsequent prophylactic measures to avoid premature ECT discontinuation. Cardiovascular responses to ECT include significant hemodynamic changes that may result in complications, even in patients without preexisting cardiovascular conditions. However, preexisting cardiovascular conditions per se are not contraindications to ECT in patients with disabling psychiatric disease. Recognizing and treating prolonged seizures is essential to prevent progression to status epilepticus. Failure to recognize and treat any of these events may result in increased mortality and morbidity. Understanding such complications and their management strategies avoids unnecessary treatment discontinuation due to manageable ECT complications.

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References and Recommended Reading

  1. Auriacombe M, Reneric JP, Usandizaga D, et al.: Post-ECT agitation and plasma lactate concentrations. J ECT 2000, 16:263–267.

    Article  PubMed  CAS  Google Scholar 

  2. Swartz CM: Electroconvulsive therapy emergence agitation and succinylcholine dose. J Nerv Ment Dis 1990, 178:455–457.

    Article  PubMed  CAS  Google Scholar 

  3. O’Reardon JP, Takieddine N, Datto CJ, Augoustides JG: Propofol for the management of emergence agitation after electroconvulsive therapy: review of a case series. J ECT 2006, 22:247–252.

    Article  PubMed  CAS  Google Scholar 

  4. Augoustides JG, Greenblatt E, Abbas MA, et al.: Clinical approach to agitation after electroconvulsive therapy: a case report and literature review. J ECT 2002, 18:213–217.

    Article  PubMed  Google Scholar 

  5. Trimble MR, Ring HA, Schmitz B: Neuropsychiatric aspects of epilepsy. In Neuropsychiatry. Edited by Fogel BS, Schiffer RB. Baltimore: Williams and Wilkins; 1996:771–803.

    Google Scholar 

  6. Gomez J, Dally P: Intravenous tranquilization with ECT. Br J Psychiatry 1975, 127:604–608.

    Article  PubMed  CAS  Google Scholar 

  7. Logan C, Stewart J: Treatment of post electroconvulsive therapy delirium and agitation with donepezil. J ECT 2007, 23:28–29.

    Article  PubMed  Google Scholar 

  8. Vishne T, Amiaz R, Grunhaus L: Promethazine for the treatment of agitation after electroconvulsive therapy. J ECT 2005, 21:118–121.

    Article  PubMed  CAS  Google Scholar 

  9. Labbate LA, Miller JP: Midazolam for treatment of agitation after ECT. Am J Psychiatry 1995, 152:472–473.

    PubMed  CAS  Google Scholar 

  10. Small JG, Milstein V: Lithium interactions: lithium and electroconvulsive therapy. J Clin Psychopharmacol 1990, 10:346–350.

    Article  PubMed  CAS  Google Scholar 

  11. Sackeim HA, Decina P, Malitz S, et al.: Postictal excitement following bilateral and right-unilateral ECT. Am J Psychiatry 1983, 140:1367–1368.

    PubMed  CAS  Google Scholar 

  12. Swartz CM: ECT emergence agitation and methohexitalsuccinylcholine interaction. Gen Hosp Psychiatry 1993, 15:339–341.

    Article  PubMed  CAS  Google Scholar 

  13. Devanand DP, Sackeim HA: Use of increased anesthetic dose prior to electroconvulsive therapy to prevent postictal excitement. Gen Hosp Psychiatry 1992, 14:345–349.

    Article  PubMed  CAS  Google Scholar 

  14. Kelly K, Zisselman M: Update on electroconvulsive therapy (ECT) in older adults. J Am Geriatr Soc 2000, 48:560–566.

    PubMed  CAS  Google Scholar 

  15. Levin L, Wambold D, Viguera A, et al.: Homodynamic responses to ECT in a patient with critical aortic stenosis. J ECT 2000, 16:52–61.

    Article  PubMed  CAS  Google Scholar 

  16. Zielinski R, Roose S, Devanand D, et al.: Cardiovascular complications of ECT in depressed patients with cardiac disease. Am J Psychiatry 1993, 150:904–909.

    PubMed  CAS  Google Scholar 

  17. Lewis W, Richardson J, Gahagan L: Cardiovascular disturbances and their management in modified electrotherapy for psychiatric illness. N Engl J Med 1955, 252:1016–1020.

    Article  PubMed  Google Scholar 

  18. Dec W, Stern T, Welch C: The effects of electroconvulsive therapy on serial electrocardiograms and serum cardiac enzyme values. A prospective study of depressed hospitalized inpatients. JAMA 1985, 253:2525–2529.

    Article  PubMed  Google Scholar 

  19. Karliner W: Cardiovascular disease and ECT. Psychosomatics 1978, 19:238–241.

    PubMed  CAS  Google Scholar 

  20. O’Reardon J, Cristancho M, Cristancho P, et al.: Electroconvulsive therapy in a 96 year old patient with severe aortic stenosis—a case report and review of the literature. J ECT 2008, 24:96–98.

    Article  PubMed  Google Scholar 

  21. O’Reardon J, Lott J, Akthar U, et al.: Acute coronary syndrome (Takutsobo cardiomyopathy) following electroconvulsive therapy in the absence of significant coronary artery disease: case report and review of literature, J ECT 2008 (in press).

  22. Prasad A: Apical ballooning syndrome: an important differential diagnosis of acute myocardial infarction. Circulation 2007, 115:e56–e59.

    Article  PubMed  Google Scholar 

  23. Ueyama T, Kasamatsu K, Hano T, et al.: Emotional stress induces transient left ventricular hypocontraction in the rat via activation of cardiac adrenoceptors: a possible animal model of ‘tako-tsubo’ cardiomyopathy. Circ J 2002, 66:712–713.

    Article  PubMed  Google Scholar 

  24. Messina A, Paranicas MKB, Markowitz J, et al.: Effect of electroconvulsive therapy on the electrocardiogram and echocardiogram. Anesth Analg 1992, 75:511–514.

    Article  PubMed  CAS  Google Scholar 

  25. Bybee KA, Kara T, Prasad A, et al.: Systematic review: transient left ventricular apical ballooning: a syndrome that mimics ST-segment elevation myocardial infarction. Ann Intern Med 2004, 141:858–865.

    PubMed  Google Scholar 

  26. Tsuchihashi K, Ueshima K, Uchida T, et al.: Transient left ventricular apical ballooning without coronary artery stenosis: a novel heart syndrome mimicking acute myocardial infarction. Angina Pectoris-Myocardial Infarction Investigations in Japan. J Am Coll Cardiol 2001, 38:11–18.

    Article  PubMed  CAS  Google Scholar 

  27. Sienaert P, Koeck A, Bouckaert F, et al.: Prolonged ECT seizure in a patient taking Nimesulide. J ECT 2004, 20:52–53.

    PubMed  Google Scholar 

  28. Abrams R: Electroconvulsive Therapy, edn 4. New York: Oxford University Press; 2002.

    Google Scholar 

  29. American Psychiatric Association: The Practice of ECT: Recommendations for Treatment, Training and Privileging. Washington, DC: American Psychiatric Press; 2001.

    Google Scholar 

  30. Scott AI, McCreadie RG: Prolonged seizures detectable by electroencephalogram in electroconvulsive therapy. Br J Psychiatry 1999, 175:91–92.

    Article  PubMed  CAS  Google Scholar 

  31. Guttmacher LB, Cretella H: Electroconvulsive therapy in one child and three adolescents. J Clin Psychiatry 1988, 49:20–23.

    PubMed  CAS  Google Scholar 

  32. Solomons K, Holliday S, Illing M: Non-convulsive status epilepticus complicating electroconvulsive therapy. Int J Geriatr Psychiatry 1998, 13:731–734.

    Article  PubMed  CAS  Google Scholar 

  33. Beyer JL, Glenn MD, Weiner RD: Electroconvulsive Therapy: A Programmed Text, edn 2. Washington, DC: American Psychiatric Press; 1998.

    Google Scholar 

  34. Proposal for revised clinical and electroencephalographic classification of epileptic seizures: from the Commission on Classification and Terminology of the International League Against Epilepsy. Epilepsia 1981, 22:489–501.

  35. Mayer SA, Claassen J, Lokin J, et al.: Refractory status epilepticus frequency, risk factors, and impact on outcome. Arch Neurol 2002, 59:205–210.

    Article  PubMed  Google Scholar 

  36. Fink M, Kellner CH, Sackeim HA: Intractable seizures, status epilepticus, and ECT. J ECT 1999, 15:282–284.

    PubMed  CAS  Google Scholar 

  37. Povlsen UJ, Wildschiodtz G, Hogenhaven H, et al.: Nonconvulsive status epilepticus after electroconvulsive therapy. J ECT 2003, 19:164–169.

    Article  PubMed  Google Scholar 

  38. Devinsky O, Duchowny MS: Seizures after convulsive therapy: a retrospective case survey. Neurology 1983, 33:921–925.

    PubMed  CAS  Google Scholar 

  39. Balki M, Castro C, Ananthanarayan C: Status epilepticus after electroconvulsive therapy in a pregnant patient. Int J Obstet Anesth 2006, 15:325–328.

    Article  PubMed  CAS  Google Scholar 

  40. Lowenstein DH, Alldredge BK: Status epilepticus. N Engl J Med 1998, 338:970–976.

    Article  PubMed  CAS  Google Scholar 

  41. Cline JS, Roos K: Treatment of status epilepticus with electroconvulsive therapy. J ECT 2007, 23:30–32.

    Article  PubMed  Google Scholar 

  42. Treiman DM, Meyers PD, Walton NY, et al.: A comparison of four treatments for generalized convulsive status epilepticus. N Engl J Med 1998, 339:792–798.

    Article  PubMed  CAS  Google Scholar 

  43. Scott AI, Riddle W: Status epilepticus after electroconvulsive therapy. Br J Psychiatry 1989, 155:119–121.

    Article  PubMed  CAS  Google Scholar 

  44. Smith K, Keepers G: Nonconvulsive status epilepticus after ECT. Am J Psychiatry 2000, 157:1524.

    Article  PubMed  CAS  Google Scholar 

  45. Pogarell O, Ehrentraut S, Rüther T, et al.: Prolonged confusional state following electroconvulsive therapy—diagnostic clues from serial electroencephalography. Pharmacopsychiatry 2005, 38:316–320.

    Article  PubMed  CAS  Google Scholar 

  46. Kaplan PW: Assessing the outcomes in patients with nonconvulsive status epilepticus: nonconvulsive status epilepticus is underdiagnosed, potentially overtreated, and confounded by comorbidity. J Clin Neurophysiol 1999, 16:341–352.

    Article  PubMed  CAS  Google Scholar 

  47. Fink M: Nonconvulsive status epilepticus and electroconvulsive therapy. J ECT 2004, 20:131–132.

    Article  PubMed  Google Scholar 

  48. Sackeim HA, Decina P, Prohovnik I, et al.: Anticonvulsant and antidepressant properties of electroconvulsive therapy: a proposed mechanism of action. Biol Psychiatry 1983, 18:1301–1310.

    PubMed  CAS  Google Scholar 

  49. Griesemer DA, Kellner CH, Beale MD, et al.: Electroconvulsive therapy for treatment of intractable seizures. Initial findings in two children. Neurology 1997, 49:1389–1392.

    PubMed  CAS  Google Scholar 

  50. Lisanby SH, Bazil CW, Resor SR, et al.: ECT in the treatment of status epilepticus. J ECT 2001, 17:210–215.

    Article  PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Department of Psychiatry, University of Pennsylvania, 3535 Market Street, 2nd Floor, Philadelphia, PA, 19104, USA

    Mario A. Cristancho

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  1. Mario A. Cristancho
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  2. Yesne Alici
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  3. John G. Augoustides
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  4. John P. O’Reardon
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Correspondence to Mario A. Cristancho.

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Cristancho, M.A., Alici, Y., Augoustides, J.G. et al. Uncommon but serious complications associated with electroconvulsive therapy: Recognition and management for the clinician. Curr Psychiatry Rep 10, 474–480 (2008). https://doi.org/10.1007/s11920-008-0076-4

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  • DOI: https://doi.org/10.1007/s11920-008-0076-4

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