Status epilepticus, electroconvulsive therapy and malignant melanoma

Area of Science:

• Neurology
• Oncology

Background:

• Status epilepticus (SE) is a rare but serious adverse effect of electroconvulsive therapy (ECT).
• Central nervous system (CNS) metastases, particularly from melanoma, can increase seizure risk.
• The interplay between ECT, SE, and CNS malignancy requires careful consideration.

Purpose of the Study:

• To report a case of SE following ECT in a patient with CNS metastatic melanoma.
• To review the literature on SE as an adverse effect of ECT, especially in the context of brain tumors.
• To provide recommendations for managing patients with suspected CNS pathology undergoing ECT.

Main Methods:

• Case report presentation.
• Literature review of SE post-ECT and CNS metastases.
• Analysis of clinical presentation and diagnostic findings.

Main Results:

• The case describes a patient experiencing SE (both convulsive and nonconvulsive) after ECT.
• The SE was associated with previously undiagnosed CNS metastatic melanoma.
• Literature review confirms SE is a rare ECT complication, with CNS pathology being a potential contributing factor.

Conclusions:

• Patients with suspected CNS pathology, especially those with a history of cancers that metastasize to the brain like melanoma, may benefit from pre-ECT neurological consultation, neuroimaging, and electroencephalography (EEG).
• These evaluations can help mitigate the risk of SE in this vulnerable population.
• Proactive neurological assessment is crucial for safe ECT administration in patients with potential brain involvement.