Electroconvulsive therapy for psychosis in a patient with epilepsy related to hypothalamic hamartoma

Abstract

Psychosis is more common in people with temporal lobe epilepsy than it is in the general population. Treatment can be difficult in these patients because of the complex interactions between antipsychotic and antiepileptic drugs. Some antipsychotic drugs also decrease the seizure threshold. We report the case of a 49-year-old man with a hypothalamic hamartoma, with a history of both gelastic and temporal lobe seizures. The patient was rendered seizure-free after three neurosurgical procedures but developed a drug-resistant paranoid psychosis. He was treated with electroconvulsive therapy (ECT). After two weeks with six stimulations that resulted in seizures, the psychiatric phenomena disappeared completely. There was no relapse of either the psychiatric symptoms or the seizures during the 42 months of follow-up. This case report suggests that ECT might be safe for psychosis in patients with a history of seizures that have previously been successfully treated with neurosurgery, although caution should be exercised in drawing general conclusions from a single case report.

Antiepileptics in Electroconvulsive Therapy

“…In a retrospective chart review on a different group of patients, they found that all of their patients receiving ECT and BZDs experienced resolution of catatonia symptoms (n = 57) 27 . Similar findings have been replicated in single-patient case reports 18,28–30 and a case series where 3 of 4 patients experienced rapid resolution of neuroleptic malignant syndrome symptoms when receiving ECT and BZDs 21 . An additional case series (n = 4) reviewed patients who were taken off their BZDs only to become catatonic during ECT; 2 of the patients required BZDs during ECT, although 1 of them was ultimately tapered 31 …”

“…In a population study, patients who received LTG (n = 131) were statistically less likely to achieve remission 1 week (odds ratio, 0.33 [0.23–0.49]) after their last ECT session than those who did not (n = 824) 14 . This contrasts with a case report indicating that the continuation of LTG did not impact ECT 18 . Given the overall evidence, we conclude that it may be appropriate to continue some patients on LTG while receiving ECT, especially considering the clinical challenges associated with slow induction back onto this medication after a taper.…”

“…14 This contrasts with a case report indicating that the continuation of LTG did not impact ECT. 18 Given the overall evidence, we conclude that it may be appropriate to continue some patients on LTG while receiving ECT, especially considering the clinical challenges associated with slow induction back onto this medication after a taper.…”

Left Anterior-Right Temporal Electroconvulsive Therapy for Catatonia After Epilepsy Surgery

“…Ruppert et al resolved post-operative psychosis using 6 bilateral ECT treatments (380mC charge) on a 46-year-old man who had a left temporal lobectomy for epilepsy from a hypothalamic hamartoma. 4 Marchetti et al achieved full remission of post-operative psychosis and depression using 18 bilateral ECT with citalopram in a 36-year-old man who had a right temporal lobectomy for intractable complex partial seizures from right mesial temporal sclerosis. 5…”