Skeletal and Dental Fractures Associated With Electroconvulsive Therapy

During the motor seizure associated with electroconvulsive therapy (ECT), the muscles of the trunk and limbs contract forcefully and repetitively, predisposing to injuries to muscles, joints, teeth, and bones. This motor seizure is irrelevant to the therapeutic action of the treatment. It is therefore modified by the administration of an intravenous muscle relaxant, such as succinylcholine, after the administration of the anesthesia in the ECT premedication. Well-modified ECT is associated with markedly diminished skeletal muscle contractions and hence with minimal skeletal and dental risks. In this context, anecdotal reports across a range of skeletal disorders testify to the safety of well-modified ECT in ultrahigh-risk patients. Population-based data suggest that the fracture risk with modified ECT is 2 events per 100,000 ECTs; if only recent data are examined, the risk may be as low as 0.36 events per 100,000 ECTs. Population-based data also suggest that the dental fracture risk with modified ECT is 0.02% per ECT and 0.17% per ECT course. The overall magnitude of skeletal and dental fracture risk depends on patient factors and on how well the ECT procedure is performed. Preexisting bone and dental disease increase the risk; good seizure modification, proper use of bite blocks, and effective jaw immobilization during ECT reduce the risk. Careful assessment of preexisting risk and good ECT practice can minimize the risk of skeletal and dental complications during ECT.