Bifrontal Electroconvulsive Therapy in a Patient With Subcallosal Cingulate Deep Brain Stimulation for Depression

Efficacy and Safety of Electroconvulsive Therapy in Patients With Deep Brain Stimulation

“…In most of the cases of BF or BT ECT with DBS, the authors reported good cognitive tolerability of ECT, without major adverse effects 3,25,27–33,35,36,38–42 . Among those adverse effects that were reported, there were 2 cases of transient confusion, 24,26 1 case of short-term memory impairment that resolved 4 weeks after the ECT program, 23 and 1 case of significant memory impairment leading to discontinuation of BF ECT 37 . However, it should be noted that the latter case concerned a woman who had already undergone ECT treatment, very poorly tolerated, before DBS.…”

“…Case reports showed that ECT can be performed-using the MECTA spECTrum 5000 29,30,34,38,41 or Thymatron 3,23,24,26,31,32,35,[37][38][39]41,42 devices-in patients with DBS targeting the subthalamic nucleus, 3,24,26,29,30,32,34,35,38,39,41 the internal globus pallidus, 3,31 or the VIM, 23,25,42 for the treatment of movement disorders. In 1 case, the DBS target for a patient with PD was not specified.…”

“…33 When identified by authors, the DBS devices used were the Medtronic system 3,23,26,[29][30][31]34,42 and a rechargeable implantable pulse generator (St Jude Medical, St Paul, Minnesota). 37 Electroconvulsive therapy electrodes can be positioned either bifrontally (BF) 24,27,30,37,38,40,41 or bitemporally (BT), 23,26,28,29,[31][32][33][34][35]39 but a large number of articles indicated placement as far away from the DBS lead insertion point and the connecting cable as possible. Only 1 article provided additional details on the placement of the ECT electrodes: Moscarillo and Annunziata 23 specified that they placed the edge of the ECT electrode 2.5 cm away from the subcutaneous cable of the DBS that ran behind the left ear.…”

“…In all reviewed case reports, the electrical current applied and frequency of administration (2 to 3 sessions per week) did not differ from those of "conventional" ECT and continuation ECT, 23,31,33,38 as well as maintenance ECT (mECT) 3,26,[29][30][31]34,38,41 were possible. Usually, the DBS device was turned off during the entire ECT treatment period 23,24,26,27,29,41,42 or during each ECT session, 28,30,36,37,40 to limit recurrence of neurological symptoms to the furthest extent possible. For safety reasons, many authors have set the DBS voltage to 0 and turned off the DBS device either before each session 3,34,38 or for the entire duration of the ECT program.…”

“…Case reports also revealed that ECT can be used for MDD in combination with DBS targeting the subcallosal cingulate gyrus, in TRD, 27,28,37 or the VC/VS, in OCD 33 . When identified by authors, the DBS devices used were the Medtronic system 3,23,26,29–31,34,42 and a rechargeable implantable pulse generator (St Jude Medical, St Paul, Minnesota) 37 . Electroconvulsive therapy electrodes can be positioned either bifrontally (BF) 24,27,30,37,38,40,41 or bitemporally (BT), 23,26,28,29,31–35,39 but a large number of articles indicated placement as far away from the DBS lead insertion point and the connecting cable as possible.…”