Electroconvulsive Therapy for a Patient With Metallic Internal Fixation in Mandible

Abstract

Electroconvulsive therapy (ECT) in the presence of metal in the skull may cause concern among clinicians. The literature is sparse, with only a few case reports in this area. We present here a case where ECT was administered in a patient with metallic internal fixation for the fracture of mandible. The 37-year-old man presented with severe depression, suicide risk, and alcohol dependence. Administration of ECT was uneventful, with no complications during ECT or at follow-up; and there was successful resolution of symptoms. This case report demonstrates that ECT may be safe in the presence of metallic implants in mandible.

Favorable Outcome After Modified Electroconvulsive Therapy in the Perioperative Management of a Patient With Treatment-Resistant Schizophrenia and a Femoral Neck Fracture

“…To the best of our knowledge, this is the first report of ECT in the perioperative period for a patient with a fresh femoral neck fracture. There are multiple reports of ECT in patients with hip and other fractures, but these are generally after surgery, for example, Tay 3 and the second case of Dighe-Deo and Shah, 4 although the first case of Dighe-Deo and Shah 4 reported providing ECT to a patient with recent hip fracture who was being treated conservatively and was not going to receive surgery. Therefore, there are few reports of ECT performed even in patients with fresh fractures who were selected for conservative treatment, and further findings are needed.…”

“…Although there are many reports of ECT in patients with fractures, these are generally after surgery. 3,4 We report a case with favorable outcome after modified ECT in the perioperative management of a patient with treatment-resistant schizophrenia and a femoral neck fracture, without adverse events regarding the fracture.…”

“…However, the present literature available to clinicians suggests that ECT is safe to perform in these patients provided that the electrode placement is modified to minimize the risk of abnormal conduction. [1][2][3][4][5] We were unable to identify any reports in the published literature documenting the clinical outcomes of a patient undergoing ECTwith a metallic subtarsal implant. Therefore, we present a case of ECT conducted in a patient with permanent weakness of the left orbicularis oculi muscle, secondary to Ramsay Hunt Syndrome, requiring a platinum subtarsal implant to aid with the closure of the palpebrae.…”

“…Madan and Anderson 2 have recommended placing the probes equidistant from the implant to reduce the risk of electrical conductance through the transplant; however, in their case, the patient had received a metallic skull plate. Alternatively, Kar et al 4 reported successful ECT in a patient with a mandibular implant without modification of the probe position. We did not seek the opinion of bioengineers before initiating therapy because they were not accessible to us in our hospital; additionally, it was felt that the clinical situation mandated prompt treatment.…”

Electroconvulsive Therapy in a Patient With a Platinum Subtarsal Implant

“…However, the present literature available to clinicians suggests that ECT is safe to perform in these patients provided that the electrode placement is modified to minimize the risk of abnormal conduction. [1][2][3][4][5] We were unable to identify any reports in the published literature documenting the clinical outcomes of a patient undergoing ECTwith a metallic subtarsal implant. Therefore, we present a case of ECT conducted in a patient with permanent weakness of the left orbicularis oculi muscle, secondary to Ramsay Hunt Syndrome, requiring a platinum subtarsal implant to aid with the closure of the palpebrae.…”