Electroconvulsive therapy for treatment of major depression in a 100-year-old patient with severe aortic stenosis: a 5-year follow-up report

Although there is no specific age cutoff for electroconvulsive therapy (ECT) and no absolute contraindication to its use, very old age and the presence of cardiac conditions such as aortic stenosis are factors that may negatively affect the physician's decision to administer ECT in individual cases. We report our follow-up of a 100-year-old woman with severe aortic stenosis who has received ECT safely for 5 years now. No cardiac complications have emerged during this period. Her prior unipolar depressive episode with catatonic features remains in remission with a single prophylactic ECT session every 3 months. We have observed from our experience with this unique case that periodic multidisciplinary re-evaluation of the evolving risk-benefit profile of ECT is essential along with the inclusion of family members in this dialogue. Our patient's course illustrates that neither advanced age nor severe aortic stenosis is an absolute contraindication to ECT even over an extended period of time. Each case needs to be evaluated on its merits. To our knowledge, this case represents the oldest patient in the literature where ECT has been administered safely for such an extended period in the setting of severe aortic stenosis.     

Electroconvulsive therapy after coil embolization of cerebral aneurysm: a case report and literature review

ABSTRACT: We report a case of an uneventful course after electroconvulsive therapy (ECT) of a patient who had undergone coil embolization for an intracranial aneurysm 37 days earlier. There have been no reports until now of ECT after coil embolization. According to histopathologic examinations, it takes approximately 2 weeks after coil embolization for the aneurysm to become fixed. The ECT can be a therapeutic option even in patients with a previous history of coil embolization, as long as it is performed under proper anesthetic management.     

Electroconvulsive therapy and antibiotics: a case report

Infections are common comorbid conditions in hospitalized patients, including those receiving electroconvulsive therapy (ECT). In this report, we demonstrate the fluoroquinolone class of antibiotics can be associated with prolonged electroconvulsive seizure duration. We describe an 82-year-old woman treated with the fluoroquinolone, moxifloxacin, during a course of ECT. After previously tolerating ECT well, introduction of moxifloxacin for a respiratory tract infection was associated with prolonged seizure duration despite complete resolution of her respiratory complaint. Taken together with other evidence that fluoroquinolones lower seizure threshold, this report suggests fluoroquinolones should be avoided in patients receiving ECT.     

Electroconvulsive therapy and venous angiomas: two case reports and review of the literature

According to the American Psychiatric Association, the risk for complications related to the electroconvulsive therapy (ECT) treatment of patients with cerebrovascular malformations is small. The literature contains a number of case studies presenting the uneventful treatment of patients with cerebral aneurysms with ECT. However, there is a paucity of cases presenting ECT in the context of a cerebral venous angioma. In this article, we present 2 cases of patients treated with ECT who were found to have documented venous angiomas. This is followed with a brief review of the literature.     

Successful electroconvulsive therapy in an elderly man with severe thrombocytopenia: case report and literature review

Electroconvulsive therapy (ECT) is a safe and effective treatment for depression. Furthermore, modifications to ECT have made it a safe procedure for patients who were previously thought to be too ill or old to undergo the stress of convulsions. Little is known, however, of the safety of performing ECT on patients with severe thrombocytopenia. Such patients may be at increased risk for hemorrhagic complications due to the procedure. In this article, we describe the case of a 74-year-old man with major depression and myelodysplastic syndrome with associated severe thrombocytopenia, who underwent successful administration of a full course (nine treatments) of ECT. The physiologic changes caused by modified ECT and the potential risk of hemorrhage (including intracranial hemorrhage) in thrombocytopenic patients undergoing ECT are also discussed.     

Electroconvulsive therapy in a patient with severe tic and major depressive episode

A patient with a disabling tic and a major depressive episode responded partially to phenelzine, but relapsed after medication was withdrawn because of hypertensive and hepatotoxic reactions. The patient's motor and affective symptoms resolved after electroconvulsive therapy, and he remains asymptomatic after 1 year.     

Transient insight induction with electroconvulsive therapy in a patient with refractory schizophrenia: a case report and systematic literature review

Anosognosia or lack of illness awareness is a clinical manifestation of both schizophrenia and right hemispheric lesions associated with stroke, neurodegeneration, or traumatic brain injury. It is thought to result from right hemispheric dysfunction or interhemispheric disequilibrium, which provides a neuroanatomical model for illness unawareness in schizophrenia. Lack of insight contributes to medication nonadherence and poor treatment outcomes and is often refractory to pharmacological and psychological interventions. We present the first report of transient illness awareness (<8 hours) after individual bilateral electroconvulsive therapy treatments in the case of a 39-year-old man with antipsychotic refractory schizophrenia. Electroencephalography demonstrated frontal slow wave activity with shifting frontotemporal predominance, which was concurrent with the patient's transient level of insight. A systematic review of the literature on electroconvulsive therapy-induced illness awareness in schizophrenia and psychotic disorders produced zero relevant results. Future research should focus on the prospective role of focal interventions, such as transcranial magnetic stimulation, in the development of a neurophysiological model for anosognosia reversal in schizophrenia that may, in turn, contribute to novel therapeutic developments targeting lack of illness awareness.     

Electroconvulsive therapy for major depressive disorder in a patient with a permanent skull defect: A case report

Electroconvulsive therapy (ECT) is an effective and safe treatment method for a variety of psychiatric disorders, including major depressive disorder. Although there is no absolute contraindication to ECT, clinicians often hesitate to apply this method to patients with a skull defect. We report a case of ECT performed on a major depressive disorder patient with an open wound after craniectomy. We summarize successful ECT cases of patients with a permanent skull defect and discuss various factors that may influence ECT outcomes in patients with a skull defect, including electrode placement, benzodiazepines, and anticonvulsants.     

Parkinsonian syndrome in a patient with a pterional meningioma: case report and review of the literature

The onset of a Parkinsonism in a patient with intracranial meningioma is definitely rare. The authors described the case of a patient suffering from a Parkinsonian syndrome for 10 years with no evidence of clinical improvement after medical treatment. A CT-scan of the brain evidenced a right pterional intracranial meningioma. The complete surgical removal of the neoplasm succeeded in resolving the Parkinsonian syndrome. The extension of the neoplasm and of the peritumoral edema may play an important role in compressing and consequently impairing perfusion of the basal ganglia region.     

Moyamoya disease associated with stenosis of extracranial arteries: a case report and review of the literature

We report on a 6-year-old boy with a 2.5-year history of recurrent cerebral ischemic strokes and moderate systemic hypertension. Brain angio-MR examination revealed stenosis of cerebral arteries with a network of collateral vessels that are characteristic features for moyamoya disease. However, further examination, including angio-CT of abdominal vessels, revealed a significant stenosis of the aorta, celiac trunk and bilateral renal arteries. As the literature shows worse prognosis for moyamoya hypertensive patients having their blood pressure reduced, our patient, though hypertensive, remains disqualified for blood pressure reduction.     

Electroconvulsive therapy: a review

Due to its ease of administration and the widespread familiarity with electroconvulsive therapy (ECT), most psychiatrists become facile in its use without the usual background information customarily thought appropriate for most treatment modalities. It is almost paradoxical that this widely administered treatment is used frequently with limited awareness of what effects, other than clinical effectiveness, could and do occur. Consequently it is important to review the vast amount of research that has been done in the area. This seems an essential underpinning for a common treatment modality that still requires future theoretical insights regarding its efficicacy.The history of the convulsive therapies is well known.^1–5 During this development there has been documentation of the use of ECT in almost every diagnostic category of the standard nomenclature. The conditions for which ECT has been used are summarized in Table 1. However, most contemporary authors and practitioners feel that it is most indicated for treatment of severe depressions and secondary for very retarded or excited conditions. It is widely used for these disorders, perhaps in part due to the relative lack of contraindications to treatment. Particular contraindications to ECT seem to depend largely on the predilections of the author consulted. While Kalinowski states that there are no absolute contraindications to ECT, save brain tumor,⁶ others, such as Perrin, cite a long list.⁷ Obviously one is obliged to weigh therapeutic needs against the limited but very real liabilities of the treatment modality. Table 2 summarizes the contraindications to ECT that have been cited.The complications of ECT have been numerous, particularly with the use of unmodified treatment. These have been mitigated, or in some instances added to, by the use of various anesthetic and muscular-relaxant agents. Table 3 summarizes the complications that have been reported. Most of these complications are relatively benign, and there is a low mortality risk associated with the use of ECT. Table 4 summarizes the mortality data in large samples, as well as specific case reports.Although much of the foregoing is usually embodied in clinical experience with the modality, the convulsive stimulus and the convulsive and other physiologic responses are less well known. It is the intent of this paper to review these aspects of ECT in some detail.     

Psychiatric symptoms in a patient with isolated adrenocorticotropin deficiency: case report and literature review

We report a 59-year-old man with isolated adrenocorticotropin (ACTH) deficiency. The patient presented with sudden onset of delusions and hallucinations at the age of 54, which resolved gradually without treatment. Subsequently, the patient manifested stereotypy, wandering, hypobulia, and autistic symptoms, and was treated with antipsychotics for 1 year without any improvement. He suffered from neuroleptic malignant syndrome-like symptoms at the age of 59. A thorough endocrine assessment revealed isolated ACTH deficiency. After hydrocortisone supplementation, the physical and psychiatric symptoms improved dramatically. Clinicians should consider this rare disease when diagnosing patients with refractory psychiatric symptoms and unique physical symptoms of isolated ACTH deficiency.     

雷帕霉素治疗结节性硬化症合并婴儿痉挛症一例报告并文献复习

目的 探讨雷帕霉素治疗结节性硬化症合并婴儿痉挛症的临床疗效. 方法 对解放军总医院儿童医学中心2011年6月收治的1例结节性硬化症合并婴儿痉挛症患儿应用雷帕霉素治疗前后的临床表现、辅助检查方法、治疗结果等进行回顾性分析. 结果 患儿有明显的皮肤损害,主要表现为色素脱失斑,同时合并婴儿痉挛症,头颅MRI及CT均有异常改变.患儿应用雷帕霉素治疗3个月后可见色素脱失减轻,痉挛发作较前明显减少,头颅MRI显示室管膜下结节较前减小,脑电图较前改善,智能发育进步,且治疗过程中未见明显不良反应. 结论 应用雷帕霉素治疗结节性硬化症合并婴儿痉挛症有显著疗效,安全性好.     

Electroconvulsive therapy-induced symptomatic hypocalcemia in a schizophrenic patient: a case report

We present a case study of a young schizophrenic 20-year-old female patient, admitted for severe psychotic exacerbation unresponsive to several antipsychotic regimens. She was treated successfully with a course of bilateral electroconvulsive therapy, but developed symptomatic hypocalcemia of short duration after the fifth ECT treatment. There is limited information regarding the phenomenon of ECT-induced acute hypocalcemia. To the best of our knowledge, there are no previous reports of this finding in the literature. A similar phenomenon was reported many years ago in patients with primary affective illness. The possible mechanisms of this potentially life-threatening reaction are not clear and should be evaluated in further studies.     

Electroconvulsive therapy in a patient with glaucoma

Electroconvulsive therapy (ECT) is associated with a brief rise in intraocular pressure (IOP). The significance of this in glaucomatous patients is unknown. We present a patient with bilateral glaucoma status after surgery in the right eye who underwent IOP monitoring during 1 of his ECT treatments. Baseline eye pressures were normal at 16 mm Hg and 18 mm Hg immediately before the treatment in the right and left eyes, respectively. Fifteen seconds after seizure induction, there was an approximately 5 mm Hg rise in IOP in the left eye, which lasted approximately 5 minutes before returning to baseline. In the right eye, there was virtually no change in pressure during the seizure. Though further research would be helpful, this case provides evidence that in a glaucomatous patient controlled with medicines or surgery, ECT probably will not cause a significant rise in IOP.     

Visually evoked startle response in a patient with epilepsy: a case report and review of the literature

Both symptomatic and genetic, cases with hyperekplexia or startle seizures induced by acoustic stimuli, are previously reported. By contrast, startle response induced by visual stimuli is rare. While visual stimuli are more commonly associated with startle seizures, here we present an 11-year-old girl with epilepsy, motor-mental retardation, and spastic tetraparesis, who had repetitive startle responses by photic stimulation during the electroencephalogram recording, without any spike-and-wave discharges associated with the startles. We report this unique case with startle responses induced both by acoustic and photic stimuli and review the literature related to this exceptionally rare combination of symptoms.     

Early-onset Moyamoya syndrome in a patient with Down syndrome: case report and review of the literature

Moyamoya disease is a chronic occlusive cerebrovascular disorder. It can occur as a primary disease or as a syndrome associated with a variety of conditions. Usually it takes 1 to 2 years to develop a classic moyamoya pattern. We report a 20-month-old girl with Down syndrome and moyamoya syndrome who presented with seizure and hemiparesis. To our knowledge, this is the youngest case reported with moyamoya syndrome and Down syndrome. The prognosis and current treatment of moyamoya syndrome and its relation to Down syndrome are reviewed. There is some reason to speculate that the abnormalities associated with Down syndrome might create a vulnerability for the development of moyamoya syndrome.