Spontaneous Seizures and Related Electroencephalo-Graphic Findings Following Shock Therapy

Blumenthal, Irving J.

doi:10.1097/00005053-195512000-00007

Cited by 39 publications

(7 citation statements)

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“…There have been reports of spontaneous seizures in patients after ECT (389,390). However, major studies have found the incidence of spontaneous seizures following ECT to be lower than the incidence of epilepsy in the general population (391,392). Hsiao et al (393) reported the complications in 98 patients with epilepsy who received ECT and found an increase in seizure frequency in only one patient and the development of status epilepticus in two.…”

Section: Electroconvulsive Therapymentioning

confidence: 99%

Depression in Epilepsy: Etiology, Phenomenology, and Treatment

1999

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Summary: A history of depression or depressive symptomatology has been reported in up to two-thirds of patients with medically intractable epilepsy, whereas community studies have demonstrated affective disorder only in a quarter of these patients. Depression has been reported peri-and interictally. However, differentiation may be difficult in patients with frequent seizures. Most authors have found no correlation between depression and epilepsy variables. However, complex partial seizures, especially of temporal lobe origin, appear to be etiologic factors, particularly in men with left-sided foci. Depression is also more common in patients treated with polytherapy especially with barbiturates, phenytoin, and vigabatrin. Depression has also been described de novo after temporal lobectomy. Psychosocial factors also play a part, but underlying risk factors (e.g., genetic, endocrine and metabolic) may explain the increased rates of depression in people with epilepsy compared to those with other neurologic and chronic medical conditions. The depression appears to be endogenous. Patients tend to exhibit fewer neurotic traits and more psychotic symptoms such as paranoia, delusions, and persecutory auditory hallucinations. Treatment approaches include psychotherapy, rationalization of antiepileptic drug medication, antidepressant treatment, and ECT. The tricyclic and related antidepressants appear to be epileptogenic, especially in people at high risk (personal or family history of seizures, abnormal pretreatment EEG, brain damage, alcohol or substance abuse/withdrawal and concurrent use of CNS-active medication). Seizures tend to occur early in treatment or after dose increments, especially if rapidly titrated. There is little evidence that the newer antidepressants, e.g., selective serotonin reuptake inhibitors, moclobemide, venlafaxine, or nefazodone are more epileptogenic than placebo.

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Section: Electroconvulsive Therapymentioning

confidence: 99%

Depression in Epilepsy: Etiology, Phenomenology, and Treatment

1999

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“…5 These reports have also suggested that EEG abnormalities can be observed over the anterior quadrants and temporal regions. [5][6][7] Although antipsychotic medications are associated with seizures, this is very unlikely to account for these changes. No patients were taking antipsychotics associated with high seizure risk such as clozapine.…”

Section: Discussionmentioning

confidence: 99%

Temporal lobe epilepsy following maintenance electroconvulsive therapy—Electrical kindling in the human brain?

et al. 2016

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Maintenance electroconvulsive therapy (ECT) is sometimes prescribed for refractory psychiatric conditions. We describe five patients who received maintenance ECT and developed florid temporal epileptiform abnormalities on electroencephalography (EEG) despite no history of epilepsy and normal neuroimaging. All patients had received regular ECT for at least 8 months. Three patients had clinical events consistent with epileptic seizures, and video-EEG monitoring captured electrographic seizures in two patients. After cessation of ECT the EEGs normalized in all patients, and no further clinical seizures occurred. Maintenance ECT may predispose to epilepsy with a seizure focus in the temporal lobe.

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“…45-46) found reports of approximately 70 such cases in patients without a prior history of epilepsy, nearly all occurring prior to the widespread use of anesthesia with ECT. Even during that period, the incidence of spontaneous seizures did not appear greater than the incidence of epilepsy in the population as a whole (Blumenthal 1955;Kalinowsky & Hippius 1969, p. 219). This has been supported by a more recent study, involving 166 ECT patients with 1-5-year follow-up (Blackwood, Cull, Freeman, Evans & Mawdsley 1980).…”

Section: What Is the Physiologic Morbidity With Ect?mentioning

confidence: 89%

Does electroconvulsive therapy cause brain damage?

Weiner

1984

Behav Brain Sci

113

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Although the use of ECT has declined dramatically from its inception, this decrease has recently shown signs of leveling out because of ECT's powerful therapeutic effect in severely ill depressed individuals who either do not respond to pharmacologic alternatives or are too ill to tolerate a relatively lengthy drug trial. Notwithstanding its therapeutic benefits, ECT has also remained a controversial treatment modality, particularly in the eye of the public. Given the unsavory qualities associated with the word “electroconvulsive,” claims of possible, probable, or even certain brain damage with ECT have easily found listeners. A careful, nonselective assessment of data covering the areas of pathology, radiology, electrophysiology, biochemistry, and neuropsychology leads both to certain conclusions and to certain unanswered questions. ECT is not the devastating purveyor of wholesale brain damage that some of its detractors claim. For the typical individual receiving ECT, no detectable correlates of irreversible brain damage appear to occur. Still, there remains the possibility that either subtle, objectively undetectable persistent deficits, particularly in the area of autobiographic memory function, occur, or that a rarely occurring syndrome of more pervasive persistent deficits related to ECT use may be present. Clearly, more research directed toward answering these questions needs to be carried out so that the role of ECT can be more rigorously defined. While such research is pending, however, we cannot expect that the conditions that predispose to clinical referrals for ECT will disappear. Given the misery, anguish, and risk of death by suicide, starvation, or debilitation associated with severe depressive illness, for example, it still appears that ECT, at least for the present, must continue to be available.

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Spontaneous Seizures and Related Electroencephalo-Graphic Findings Following Shock Therapy

Cited by 39 publications

References 0 publications

Depression in Epilepsy: Etiology, Phenomenology, and Treatment

Depression in Epilepsy: Etiology, Phenomenology, and Treatment

Temporal lobe epilepsy following maintenance electroconvulsive therapy—Electrical kindling in the human brain?

Does electroconvulsive therapy cause brain damage?

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