Aortic stenosis confers an increased risk of complications during procedures with general anesthesia. There are no previously reported cases of electroconvulsive therapy (ECT) in patients with this valvular defect. Two cases are described of patients with moderate to severe aortic stenosis confirmed by echocardiography in whom courses of ECT resulted in clinical improvement without untoward cardiac complications. It is concluded that ECT can be safely given to patients with aortic stenosis in whom left ventricular function is normal.
Electroconvulsive therapy (ECT) is used in adolescent psychiatric practice, yet few studies have been conducted to assess its use for 13-19-year-olds. Efficacy, indications, side effects, technical characteristics, and outcome are uncertain. We retrospectively reviewed the medical records of 21 adolescents treated with bilateral ECT in our department from 1984 through 1995. In our series, ECT was effective in treating both maniac and depressive episodes, with a high rate of relapse at 1 year follow-up (approximately 40%). Clinical improvement was only partial and in schizophrenia and schizoaffective episodes. Seizure threshold was associated with gender, but not with the cumulative number of treatments. Adverse effects were frequent, but were usually transient with only moderate discomfort, even in patients with concomitant medical problems. We conclude that ECT is a safe and effective treatment for adolescents with severe and intractable mental illness, and it has the same indications and effects as in adults.
We provide case reports of the successful use of electroconvulsive therapy (ECT) for intractable mania in two prepubertal male children. Both children responded well to ECT without significant complications. The report focuses in particular on the procedure and technique of doing ECT in this patient population.
Many patients who receive electroconvulsive therapy (ECT) are benzodiazepine dependent or are anxious and require benzodiazepine drugs. Because these agents may diminish the therapeutic effectiveness of ECT, we explored the dosing, safety, and efficacy of pre-ECT flumazenil administration, a benzodiazepine-competitive antagonist, in patients receiving benzodiazepine medications. We report our experience with 35 patients who received both flumazenil and benzodiazepine drugs during their ECT course. We compared seizure duration with and without flumazenil and compared treatment efficacy to 49 patients who received ECT without either of these medications. Flumazenil could be safely administered with ECT. A few subjects taking higher chronic benzodiazepine dosages experienced breakthrough anxiety or withdrawal symptoms, which were well managed by dosing flumazenil immediately before the anesthetic agent and by immediate posttreatment benzodiazepine administration. A dose of 0.4-0.5 mg was adequate for all but those taking the highest benzodiazepine dosages, where 0.8-1.0 mg resulted in a clinically more effective reversal. No differences in efficacy or seizure duration were found as a function of flumazenil administration. Flumazenil offers the promise of safe and effective ECT in patients receiving benzodiazepine drugs. Follow-up outcome investigation on a random assignment basis will be necessary for definitive assessment of the value of flumazenil. In addition, the direct effect of benzodiazepine drugs and the flumazenil/benzodiazepine combination on ECT seizures remains to be determined.
A 41-year-old man with a left ventricular aneurysm received electroconvulsive therapy (ECT) for treatment of depression, tolerating the procedure without any cardiovascular complications. This case suggests that ECT may be safely administered to patients with ventricular aneurysm and multiple cardiac risk factors provided that additional precautions are taken.
