Use of ECT for Children With and Without Catatonia: A Single-Site Retrospective Analysis
Joshua R Smith, Isaac Baldwin1, Katherine Audrey Termini1
1Division of General Psychiatry, Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center.
Insights
Electroconvulsive therapy (ECT) is safe and effective for pediatric patients with psychiatric conditions like catatonia, psychosis, and suicidal ideation. While generally well-tolerated, prolonged seizures occurred in some cases, requiring further research.
Area of Science:
- Child and Adolescent Psychiatry
- Neuroscience
- Medical Ethics
Background:
- Electroconvulsive therapy (ECT) is an established treatment for severe psychiatric disorders in adults.
- The use of ECT in pediatric populations is less understood, necessitating further investigation into its safety and efficacy in this age group.
Purpose of the Study:
- To investigate the safety and efficacy of electroconvulsive therapy (ECT) in a retrospective cohort of pediatric patients.
- To evaluate treatment outcomes and adverse events associated with pediatric ECT.
Main Methods:
- A retrospective analysis of 36 pediatric patients (under 18 years) who received ECT between January 2012 and April 2023.
- Efficacy was assessed using the Clinical Global Impressions-Improvement scale and the Bush-Francis Catatonia Rating Scale.
- Adverse events were determined through medical record review.
Main Results:
- Catatonia was the most common indication for ECT, followed by psychosis and suicidal ideation.
- A high probability (0.852) of significant improvement was observed across all patients.
- Patients with catatonia showed significant improvement, with a statistically significant reduction in Bush-Francis Catatonia Rating Scale scores.
- No significant adverse events were reported, although 38.9% experienced prolonged seizures, all successfully terminated with propofol.
Conclusions:
- Pediatric ECT is a safe and effective treatment option for various psychiatric conditions in young patients.
- Further research is warranted to identify risk factors for prolonged seizures and optimize seizure parameters in pediatric ECT.
Objectives:
The objective study was to investigate the safety and efficacy of electroconvulsive therapy (ECT) in a retrospective cohort of pediatric patients.
Methods:
A single-site retrospective analysis was conducted of patients aged younger than 18 years who received ECT in a private university hospital from January 28, 2012 to April 8, 2023. Treatment efficacy and adverse events were determined retrospectively through review of the medical record.
Results:
A total of 36 pediatric patients met the inclusion criteria. Catatonia was the most common presenting indication for ECT, followed by psychosis and suicidal ideation. For all patients, Clinical Global Impressions-Improvement scale scores indicated that it was very likely for a subject to experience at least "much improvement" with the estimated probability of receiving a Clinical Global Impressions-Improvement scale score better than 3 of 0.852 (t.s. = 16.3; P < 0.001; 95% confidence interval, 0.711-0.931). All patients with catatonia demonstrated a positive clinical response and experienced a statistically significant reduction in total Bush-Francis Catatonia Rating Scale scores observed ( t = 11.9; df = 20; SD = 6.3; P < 0.001; 95% confidence interval, 12.6-17.9). No significant adverse events were reported for any patient in the cohort. However, 14 (38.9%) patients experienced prolonged seizures, all of which were terminated with propofol (mean, 49.7 mg).
Conclusions:
This study provides further data supporting the safe and effective use of pediatric ECT in the treatment of various psychiatric conditions. However, more research is needed to determine the risk factors associated with prolonged seizures and the optimal seizure parameters in young people.
