The Efficacy and Tolerability of Electroconvulsive Therapy in Psychiatric Patients with Arachnoid Cysts: A Retrospective Chart Study

Abstract

Electroconvulsive therapy (ECT) is an effective therapy for many psychiatric illnesses. However, intracranial occupying lesions are a relative contraindication to ECT. Arachnoid cysts are benign, congenital, and space-occupying lesions. Our study aimed to evaluate the efficacy and tolerability of ECT in psychiatric patients with arachnoid cysts. We retrospectively identified 62 psychiatric patients with arachnoid cysts; 43 of them underwent ECT and 19 did not. Their conditions were assessed by CGI-S and different scales depending on different diagnoses (PANSS for schizophrenia; HAMD for depression; YMRS for bipolar disorder). The side effect was assessed by TESS. Significant differences were shown in the reduced scores of the CGI-S between patients who underwent ECT and those who did not (p = 0.001), while, at the same time, there was no significant difference in their TESS score (p = 0.297). The current study found that ECT is an effective and tolerable therapy for psychiatric patients with arachnoid cysts.

Electroconvulsive therapy: a last resort for lorazepam-resistant catatonia in patient with large arachnoid cyst

“…Arachnoid cyst is one such intracranial space-occupying lesion that can present with psychiatric manifestations like-catatonia. [1][2][3] Arachnoid cysts are primarily benign lesions and are often detected accidentally. 4 We report here a young man with lorazepam nonresponsive catatonic schizophrenia with an arachnoid cyst, who was treated with electroconvulsive therapy (ECT) safely and needed maintenance ECT due to reemergence of catatonic symptoms following discontinuation of ECT after acute management of catatonia A 20-year-old male was brought in for psychiatric consultation by his family due to concerning symptoms.…”

“…Sometimes, the lesions are incidentally reported during neuroimaging, indicating that the person may remain asymptomatic despite having a space-occupying lesion. Arachnoid cyst is one such intracranial space-occupying lesion that can present with psychiatric manifestations like—catatonia 1 – 3 . Arachnoid cysts are primarily benign lesions and are often detected accidentally 4 .…”

“…However, in our case, the patient’s intracranial pressure was normal (as evident from the fundoscopic examination), which may have prevented the development of any neurological side effects following ECT treatment. Earlier evidences support the use of ECT to treat catatonia in patients with arachnoid cyst, though the evidence is limited to few published case reports 2 , 5 and a retrospective chart review, 3 which indicate that ECT is a safe and effective procedure to treat catatonic symptoms and other psychiatric manifestations in patients with arachnoid cysts. One unique feature in our case is reemergence of catatonic symptoms following discontinuation of ECT and resolution of the symptoms with maintenance ECT.…”