Abstracts

Rationale: Electroconvulsive therapy (ECT) is a treatment using brief electrical stimulation of the brain for patients with severe, refractory major depression or bipolar disorder. ECT has been also used in the treatment of patients with epilepsy and concomitant psychiatric disorders. No current evidence to date has shown an increased risk of epilepsy following ECT, however we report a case of a 21-year-old female who was treated with 30 sessions of ECT for retarded catatonia who then developed epilepsy.

Methods: The objective of our study was to present this case in the context of a literature review on the incidence of spontaneous seizures after ECT, compiling findings from epidemiologic studies to isolated case reports with an emphasis on patient risk factors, treatment number, and described interictal EEG patterns and seizure semiology in cases that developed post-ECT.

Results: The relationship between ECT and new-onset epilepsy remains controversial based on current findings. Specifically, two retrospective epidemiologic surveys of patients treated with ECT was unable to demonstrate an increased risk of ECT-induced epilepsy when accounting for individual risk factors.^1,2 However, newer isolated cases reports have described patients on maintenance ECT who then developed definite or possible epilepsy, though a causal pattern has yet to be recognized.^3-5  In recent documented cases, the median number of administered ECT sessions at the time of diagnosis of epilepsy was 92. Interestingly, in several cases patients who received bitemporal electrode placement went on to develop temporal lobe epilepsy.^4,5

Conclusions: This case presents a patient who developed right anterior temporal epileptiform discharges a few days after her last ECT session in the same anatomic site present on two routine EEG’s three days apart, with an episode of unexplained urinary incontinence and amnestic spells, concerning for seizure activity. Ultimately, this case may support the theory of epileptogenic kindling as the potential mechanism by which prior documented cases of ECT-induced epilepsy have developed and provide further evidence that may warrant re-investigation into the risk association between ECT and new-onset epilepsy.
_x000D_ References:_x000D_ 1.   Blackwood DHR, Cull RE, Freeman CPL, et al. A study of the incidence of epilepsy following ECT. J Neurol Neurosurg Psychiatry. 1980;43:1098-1102._x000D_ 2.   Devinsky O, Duchowny MS. Seizures after convulsive therapy: a retrospective case survey. Neurology. 1983;33:921-925._x000D_ 3.   Rasmussen KG, Lunde ME. Patients who develop epilepsy during extended treatment with electroconvulsive therapy. Seizure. 2007;16:266-270.

Funding: None