P 107. Performance of electroconvulsive therapy in a patient with clipping of the middle intracerebral artery (Yasargil titanium clip) without major complications

Gahr, Maximilian; Connemann, Bernhard J.; Hawlik, Andreas E.; Scönfeldt-Lecuona, E.C.

doi:10.1016/j.clinph.2013.04.185

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“…Currently, literature merely provides few anecdotal reports (Najiar and Guttmacher, 1998) and manufacturers of such clipping systems (usually made of titanium) refrain from any suggestions concerning the safety during the performance of ECT. Currently, literature merely provides few anecdotal reports (Najiar and Guttmacher, 1998) and manufacturers of such clipping systems (usually made of titanium) refrain from any suggestions concerning the safety during the performance of ECT.…”

Section: Referencesmentioning

confidence: 99%

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P 109. Therapeutic efficacy of continuous theta-burst magnetic stimulation (cTBS) in major depression. A double-blind sham-controlled study

Chistyakov

Kreinin

Kaplan

et al. 2013

Clinical Neurophysiology

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ReferencesBalconi M, Bortolotti A, Gonzaga L. Emotional face recognition, EMG response, and medial prefrontal activity in empathic behavior. Neurosci Res tul=0?>Balconi et al.,;71:251-9. Balconi M, Bortolotti A. Resonance mechanism in empathic behavior. BEES, BIS/BAS and psychophysiological contribution. Physiol Behav 2012;105:298-304. Balconi M, Bortolotti A. Detection of the facial expression of emotion and self-report measures in empathic situations are influenced by sensorimotor circuit inhibition by low-frequency rTMS. Brain Stimul 2012;5:330-6.Question: Little is known regarding the risks of electroconvulsive therapy (ECT) in patients with clippings of intracerebral aneurysms. Currently, literature merely provides few anecdotal reports (Najiar and Guttmacher, 1998) and manufacturers of such clipping systems (usually made of titanium) refrain from any suggestions concerning the safety during the performance of ECT. Thus, clinicians facing the coincidence of therapy-refractory depression (suggesting performance of ECT) and presence of intracerebral clips have to trade of possible benefits of ECT against theoretical risks in the complete absence of any guidelines or recommendations. Indeed, titanium is principally inert and the application of electric current should therefore not result in significant warming (with the risk of damaging surrounding brain tissue). However, the indication of ECT under these conditions must be confirmed meticulously.Methods: A case report is presented in order to to contribute to the available experience concerning this clinical situation.Results: We present the case of a 55-year old female patient who successfully underwent clipping (Yasargil Titanium Clip, Aesculap Ò ) of the left middle cerebral artery (MCA) due to MCA-aneurysm three years prior. The patient suffered from treatment-refractory major depressive disorder (recurrent type). Taking into account that various pharmacologic treatment attempts failed, ECT was considered. The patient was comprehensively informed about possible risks of the procedure related to the titanium clip. Before ECT CT-angiography was performed showing no re-development of the surgically treated aneurysm or development of new aneurysms. 12 cycles of right-unilateral ECT were performed without any complications despite ECT-related tachycardia. During ECT the patient was treated with esmolol. Subsequently, the patient's clinical situation significantly improved.Conclusions: Though clear guidelines or suggestions of manufacturers of neurosurgical clips regarding safety during ECT are absent we did not observe any major complications during ECT in a patient with an intracerebral Yasargil titanium clip. However, the material behaviour of titanium during application of electric current remains to be studied systematically in order to rule out problematic warming with the risk of tissue damage.

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confidence: 99%