Does a history of surgically repaired intracranial aneurysm interfere with electroconvulsive therapy?
Ibrahim Karakaya, Koray Basar, Ozlem Erden Aki, Suzan Ozer
Dusunen Adam The Journal of Psychiatry and Neurological Sciences
2018;31:308-311
Article No:
10
Article Type :
Case Report
Electroconvulsive therapy (ECT) is a comparably safe treatment option frequently administered for treatment-refractory mental disorders. It has no absolute contraindication; however, careful attention should be given when ECT is applied to patients with comorbid conditions. Intracranial aneurysms are among the comorbidities that increase certain risks associated with ECT. Increase in cerebral blood flow during ECT may be associated with increased risk of rupture of an aneurysm and bleeding from vascular malformation. In the literature, there is a limited number of case reports on ECT administration in patients with surgically repaired cerebral aneurysm. In this case report, application of ECT in a 53-year-old female patient diagnosed with treatment-refractory major depressive disorder and with a history of surgical repair for intracranial aneurysm is presented. In addition, special considerations and precautions about ECT application for patients with repaired intracranial aneurysms are reviewed.
Keywords :
Depression, electroconvulsive therapy, intracranial aneurism
Geçirilmiş intrakranial anevrizma operasyonu elektrokonvülzif tedavi için bir engel mi?
Makale No:
10
Makale Türü :
Olgu Sunumu
Elektrokonvülzif tedavi (EKT) tedaviye dirençli ruhsal bozukluklarda uygulanan, görece güvenli bir tedavi yöntemidir. Kesin kontrendikasyonu bulunmasa da tıbbi ek tanıları olan hastalarda EKT uygulanırken dikkatli davranılması gerekmektedir. İntrakranial anevrizma, EKT uygulanırken risk oluşturabileceği düşünülen tıbbi tanılardandır. EKT sırasında serebral kan akımı ve kafa içi basınç artarak anevrizma rüptürü ve vasküler malformasyon kanaması riskini arttırabilir. Tıbbi yazında çeşitli yöntemlerle onarılmış intrakranial anevrizması olan hastalara EKT uygulanmasıyla ilgili sınırlı sayıda olgu sunumu mevcuttur. Bu yazıda 53 yaşında, anevrizma operasyonu öyküsü olan, majör depresif bozukluk tanısı ile takip edilen, ilaç tedavisinden yarar görmemiş kadın hastada yapılan EKT uygulaması sunulmuş ve bu vaka üzerinden intrakranial anevrizması olan hastalarda EKT uygulaması sırasında dikkat edilecek hususlar tartışılmıştır.
Anahtar kelimeler :
Depresyon, elektrokonvülzif tedavi, intrakranial anevrizma
REFERENCES
1.American Psychiatric Association. The Practice of Electroconvulsive Therapy: Recommendations for Treatment, Training and Privileging: A Task Force Report of the American Psychiatric Association. Second ed. Washington DC: American Psychiatric Association, 2001.
2.Gaines GY, Rees DI. Electroconvulsive therapy and anesthetic considerations. Anesth Analg 1986; 65:1345-1356.
3.Okamura T, Kudo K, Sata N, Sameshima T, Doi N, Kato N. Electroconvulsive therapy after coil embolization of cerebral aneurysm: a case report and literature review. J ECT 2006; 22:148-149.
4.van Herck E, Sienaert P, Hagon A. Electroconvulsive therapy for patient with inracranial aneurysms: a case study and literature review. Tijdschr Psychiatr 2009; 51:43-51. (Dutch)
5.Sharma A, Ramaswamy S, Bhatia SC. Electroconvulsive therapy after repair of cerebral aneurysm. J ECT 2005; 21:180-181.
6.Salaris S, Szuba MP, Traber K. ECT and intracranial vascular masses. J ECT 2000; 16:198-203.
7.Mayor S. ECT may be better than drugs for short term depression. BMJ 2003; 326:569.
8.Bader GM, Silk KR, Dequardo JR, Tandon R. Electroconvulsive therapy and intracranial aneurysm. Convuls Ther 1995; 11:139-143.
9.Drop LJ, Bouckoms AJ, Welch CA. Arterial hypertension and multiple cerebral aneurysms in a patient treated with electroconvulsive therapy. J Clin Psychiatry 1998; 49:280-282.
10.Najjar F, Guttmacher LB. ECT in the presence of intracranial aneurysm. J ECT 1998; 14:266-271.
11.The International Study of Unruptured Intracranial Aneurysms Investigators. Unruptured intracranial aneurysms--risk of rupture and risks of surgical intervention. N Engl J Med 1998; 339:1725-1733.
12.Wilkinson ST, Helgeson L, Ostroff RB. Electroconvulsive therapy and cerebral aneurysms. J ECT 2014; 30:47-49.
13.Stadtland C, Erfurth A, Ruta U, Michael N. A switch from propofol to etomidate during an ECT course increases EEG and motor seizure duration. J ECT 2002; 18:22-25.
14.Rakesh G, Thirthalli J, Kumar CN, Muralidharan K, Phutane VH, Gangadhar BN. Concomitant anticonvulsants with bitemporal electroconvulsive therapy: a randomized controlled trial with clinical and neurobiological application. J ECT 2017; 33:16-21.
15.Frey R, Schreinzer D, Heiden A, Kasper S. Use of electroconvulsive therapy in psychiatry. Nervenarzt 2001; 72:661-676. (German)
16.Ceylan ME, Oral ET. Biological Psychiatry in Research and Clinical Application: Mood Disorders. First ed., vol. 4, Istanbul: Yesilyurt Kitabevi, 2001, 401. (Turkish)