Safety of Electroconvulsive Therapy With Implanted Ventricular Shunts: A Systematic Review and Case Series

We aim to determine the safety and outcomes of electroconvulsive therapy (ECT) in patients with ventricular shunts, with a focus on shunt function after treatment.

We conducted a retrospective analysis of all patients with ventriculoperitoneal shunts who underwent ECT at the Massachusetts General Hospital between November 2021 and November 2024. We also conducted a systematic review of the literature to identify all studies published between November 1, 1964, and November 1, 2024, reporting the use of ECT in patients with implanted cerebrospinal fluid shunts.

Our case cohort comprised 4 patients with implanted programmable VP shunts, of which, 2 cases demonstrated evidence of valve setting changes after ECT. Across all the cases, ECT was effective in reducing psychiatric symptoms without evidence of shunt malfunction, albeit with some ECT-related adverse side effects. Our search yielded 115 studies, of which 12 met the inclusion criteria for review. These studies described the successful administration of ECT in patients with implanted cerebrospinal fluid shunts, with no reports of shunt malfunction or requirement for revision.

ECT appears to be a safe and effective treatment for psychiatric patients with indwelling ventricular shunts. ECT administered to patients with programmable shunt valves require particular attention with evaluation for shunt setting changes and reprogramming to pre-ECT settings when appropriate. Our findings support the need for a multidisciplinary approach, involving psychiatry, anesthesia, and neurosurgical teams, to mitigate risks and optimize care in this unique patient population.