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Monitoring Intracranial Pressure Change Through Optic Nerve Sheath Ultrasound During Electroconvulsive Therapy
Irem Aksoy1, Demet Lafli Tunay1, Mustafa Aksoy2
1Department of Anesthesiology and Reanimation, Faculty of Medicine.
The Journal of ECT
|September 16, 2025
Summary
Electroconvulsive therapy (ECT) may transiently increase intracranial pressure (ICP), as indicated by optic nerve sheath diameter (ONSD) measurements. This effect is more pronounced in hypertensive patients, necessitating careful monitoring during ECT procedures.
Area of Science:
- Neurology
- Psychiatry
- Critical Care Medicine
Background:
- Electroconvulsive therapy (ECT) is a vital treatment for psychiatric disorders.
- The impact of ECT on intracranial pressure (ICP) remains incompletely understood.
- Optic nerve sheath diameter (ONSD) measured via ultrasonography is a non-invasive ICP indicator.
Purpose of the Study:
- To prospectively evaluate the effect of ECT on ICP.
- To measure changes in ONSD during and after ECT.
- To identify patient factors influencing ECT-induced ICP changes.
Main Methods:
- Prospective observational study of 39 patients undergoing their first ECT session.
- ONSD measurements taken pre-anesthesia, post-anesthesia, post-ictal, and during recovery.
- Clinical data including vital signs, seizure duration, and comorbidities were recorded.
Main Results:
- Post-ictal ONSD was significantly elevated compared to pre-ECT measurements (P < 0.001).
- The increase in ONSD during ECT correlated positively with blood pressure.
- Hypertensive patients exhibited significantly greater ONSD changes during ECT (P = 0.001).
Conclusions:
- ECT can induce a transient increase in ICP in patients without intracranial lesions.
- Hypertension may exacerbate ECT-associated ICP elevations.
- Close ICP monitoring is crucial for hypertensive patients undergoing ECT.
