Electroconvulsive Therapy in the Presence of a Metallic Skull Plate After Meningioma Resection

Abstract

Electroconvulsive therapy (ECT) is an effective and safe treatment even in the frail and in the medically ill. A case report of ECT being administered to a patient with a history of a recently resected meningioma and the presence of a metallic skull plate is presented here. The patient has a history of bipolar disorder in remission but had an acute manic episode with psychotic features after resection of suprasellar meningioma. He presented with superimposed delirium that complicated the presentation. Because there was no effective resolution with medications, ECT was administered. This case documents the safe administration of ECT in complicated situations such as these. This case also demonstrates that ECT can be successfully administered in the presence of superimposed delirium and after a recent meningioma resection. Clinical skills and expertise are required to safely and effectively administer ECT in such cases.

A systematic review of left unilateral electroconvulsive therapy

“…Left‐sided electrode placement was chosen either because RUL treatment caused delirium or because of a skull defect or presence of metallic cranial implants. These patients did not experience any complications from treatment, and no negative cognitive effects were noted; in one case, the authors pointed out that post‐treatment mini‐mental state examination (MMSE) scores had improved significantly . One report described the successful use of left‐sided maintenance ECT as well .…”

“…In contrast to the clinical trials, none of the case reports of LUL ECT included specific memory tests or detailed cognitive assessments, making it difficult to draw any conclusions from them. Two patients improved or maintained their MMSE scores over the course of treatment , and three patients were successfully switched from RUL to LUL ECT to resolve postictal agitation . Three patients became delirious after LUL ECT, but the incidence of this compared to RUL is unknown .…”

“…Ling et al (2010) reported the case of a 54‐year‐old male patient with bipolar disorder, originally hospitalized for a meningioma resection, during which the skull was repaired with a metallic plate. A few weeks after surgery, he became manic and psychotic, requiring ECT; LUL ECT was administered with modified electrode placement (temporal and occipital) to avoid the metal plate.…”

Is Electroconvulsive Therapy Safe in the Presence of an Intracranial Metallic Object?

“…Yamamoto et al 28 report a patient developing irreversible brain damage after cardioversion. 24 In the other cases, no preventive measures to prevent the current from interfering with the metal objects were mentioned. However, the exact mechanism of brain lesioning could not be fully explained.…”

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.…”