Tardive Seizures After Electroconvulsive Therapy

Area of Science:

• Neurology
• Psychiatry

Background:

• Tardive seizures are spontaneous seizures occurring after electroconvulsive therapy (ECT).
• They are considered a rare complication of ECT, influenced by factors affecting seizure threshold.
• Limited data exists on tardive seizures specifically within the context of modified ECT.

Purpose of the Study:

• To review the literature on tardive seizures following modified ECT.
• To provide clinical guidance for managing patients who experience tardive seizures during ECT treatment.

Main Methods:

• A comprehensive literature search was conducted across PubMed, EMBASE, PsycInfo, and CINAHL databases up to May 2021.
• Cases of modified ECT with tardive seizures occurring within 7 days of the index ECT seizure were identified.
• Data collected included patient demographics, medical history, medications, anesthetic details, ECT parameters, and management strategies.

Main Results:

• 39 episodes of modified ECT-related tardive seizures were reported over 40 years.
• Over 97% of cases had identifiable risk factors, such as seizure-lowering medications or neurological conditions.
• Major complications were rare (<15%), but serious adverse events including fetal death and suicide were noted. Most patients (over 50%) were successfully retreated with ECT, with only 15% experiencing recurrent tardive seizures.

Conclusions:

• Tardive seizures are a rare complication of modified ECT.
• Reinitiating ECT after a tardive seizure is feasible following a thorough review of modifiable seizure risk factors.
• Consideration of antiepileptic medications and enhanced post-ECT monitoring is recommended.