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Pupillary Response as Assessment of Effective Seizure Induction by Electroconvulsive Therapy
Published on: April 11, 2019
Drug-Resistant Psychosis in a Tuberous Sclerosis Patient Treated With Electroconvulsive Therapy
Hasan B Kayaci1, Lala Allahyarova2, Nevzat Tarhan3
1Department of Neurology, Üsküdar University, NPİstanbul Brain Hospital.
The Journal of ECT
|May 31, 2026
Summary
Electroconvulsive therapy (ECT) effectively treated severe psychosis in a Tuberous Sclerosis Complex (TSC) patient experiencing forced normalization after epilepsy surgery. This safe treatment option is viable even with neurological complications.
Area of Science:
- Neuroscience
- Psychiatry
- Genetics
Background:
- Tuberous Sclerosis Complex (TSC) frequently causes severe neuropsychiatric disorders (TAND).
- Epilepsy and psychosis are common TAND manifestations, often resistant to standard treatments.
- Surgical intervention for epilepsy in TSC can sometimes precipitate or worsen psychiatric symptoms, a phenomenon termed 'forced normalization'.
Purpose of the Study:
- To investigate the efficacy and safety of electroconvulsive therapy (ECT) for treatment-resistant psychosis in a patient with Tuberous Sclerosis Complex (TSC).
- To explore the potential role of forced normalization in the psychiatric deterioration following epilepsy surgery in TSC.
- To evaluate ECT as a therapeutic option for severe TAND psychosis unresponsive to pharmacotherapy.
Main Methods:
- Case study of a 17-year-old male with TSC, uncontrolled epilepsy, and subsequent treatment-resistant psychosis post-neurosurgery.
- Administration of 18 ECT sessions (inpatient and outpatient) with a tapering maintenance schedule.
- Careful consideration of patient's risk factors including postsurgical cortical defect and history of status epilepticus.
Main Results:
- Successful elimination of psychotic symptoms including agitation and hallucinations following ECT.
- No neurological complications were observed during or after the ECT treatment course.
- The patient achieved seizure control through surgery, followed by psychiatric stabilization with ECT, indicating a complex interplay of TAND manifestations.
Conclusions:
- Electroconvulsive therapy (ECT) is a safe and effective treatment for severe Tuberous Sclerosis Complex-associated neuropsychiatric disorder (TAND) psychosis, particularly in cases of forced normalization.
- ECT offers a viable therapeutic strategy for patients with treatment-resistant psychosis and underlying structural brain changes post-neurosurgery.
- This case highlights the importance of considering ECT for refractory TAND psychosis, even in the presence of significant neurological risk factors.
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