Temporal lobe epilepsy following maintenance electroconvulsive therapy—Electrical kindling in the human brain?

Abstract

Maintenance electroconvulsive therapy (ECT) is sometimes prescribed for refractory psychiatric conditions. We describe five patients who received maintenance ECT and developed florid temporal epileptiform abnormalities on electroencephalography (EEG) despite no history of epilepsy and normal neuroimaging. All patients had received regular ECT for at least 8 months. Three patients had clinical events consistent with epileptic seizures, and video-EEG monitoring captured electrographic seizures in two patients. After cessation of ECT the EEGs normalized in all patients, and no further clinical seizures occurred. Maintenance ECT may predispose to epilepsy with a seizure focus in the temporal lobe.

Development of temporal lobe epilepsy during maintenance electroconvulsive therapy: A case of human kindling?

“…11,12 Furthermore, new-onset epilepsy after long-term ECT has been documented. 13,14 Bryson and colleagues hypothesized electrical kindling as a possible mechanism of epileptogenesis in these patients. 14 We report a patient receiving maintenance ECT for 22 years, who developed temporal lobe epilepsy (TLE), which was not controlled by 2 AEDs.…”

“…[7][8][9][10] On the other hand, several case reports have documented status epilepticus after ECT. 13,14 Bryson and colleagues hypothesized electrical kindling as a possible mechanism of epileptogenesis in these patients. 13,14 Bryson and colleagues hypothesized electrical kindling as a possible mechanism of epileptogenesis in these patients.…”

“…11,12 Furthermore, new-onset epilepsy after long-term ECT has been documented. 14 We report a patient receiving maintenance ECT for 22 years, who developed temporal lobe epilepsy (TLE), which was not controlled by 2 AEDs. 14 We report a patient receiving maintenance ECT for 22 years, who developed temporal lobe epilepsy (TLE), which was not controlled by 2 AEDs.…”

Commentary on Schotte et al. “Development of temporal lobe epilepsy during maintenance electroconvulsive therapy: A case of human kindling?”

“…Prior reports of epilepsy diagnosed after many episodes of ECT included focal or bilateral onset seizures, while epileptic activity after bitemporal ECT or ipsilateral temporal onset seizures have been reported after unilateral ECT 22,23 and often subside after ECT discontinuation. In this case, this will resemble the studies in the GEPR-3 audiogenic-prone rats and one would have to assume that the ECT seizures are of brainstem origin.…”

“…In this case, this will resemble the studies in the GEPR-3 audiogenic-prone rats and one would have to assume that the ECT seizures are of brainstem origin. Prior reports of epilepsy diagnosed after many episodes of ECT included focal or bilateral onset seizures, while epileptic activity after bitemporal ECT or ipsilateral temporal onset seizures have been reported after unilateral ECT 22,23 and often subside after ECT discontinuation. However, as was the case in the patient described by Schotte et al, ECT discontinuation may not always be possible due to the severity of depression.…”