The Safety of Electroconvulsive Therapy in Patients With Implanted Deep Brain Stimulators

Abstract

Currently there is no consensus statement about the safety of electroconvulsive therapy in patients who have implanted electrodes for deep brain stimulation. We present a summary of the existing literature on this topic, consisting of 21 cases, and then report a case performed at the University of Maryland Medical Center. Notably, with appropriate safety precautions and careful patient selection, there were no adverse events reported in the literature that were related to the presence of the deep brain stimulation device in any of the cases. Based on our review of the literature and the case we present, we have found no evidence so far to indicate that electroconvulsive therapy in patients with an implanted deep brain stimulator is unsafe.

Safe and successful treatment of depression with electroconvulsive therapy in a patient with implanted spinal cord stimulators

“…Alternatively, there was the postulated risk that exposure of a metallic DBS (or SCS) electrode to the electrical current delivered during ECT could cause heating of the electrode and damage surrounding brain tissue. At least with DBS however, Peroski et al found no case report evidence that ECT caused tissue damage in patients with implanted DBS devices or that DBS was unsafe in this patient group [4]. With respect to ECT's safety in patients with implanted SCS, more research and reporting of adverse events are needed to guide clinical decision-making.…”

“…ECT is an antidepressant intervention which involves the passage of an electrical current through pre-determined electrode configurations placed on the recipient's scalp to induce a seizure. Whilst a recent case report and literature review reported on the safety of ECT in patients with implanted deep brain stimulators (DBS) [4], there is no literature describing the feasibility, safety or efficacy of ECT applied to patients with implanted SCS.…”

“…Our patient did not experience any significant adverse effects attributable to the presence or malfunction of an SCS during a course of twelve sessions of ECT. Similar to safety concerns raised about DBS and ECT [4], the theoretical possibility existed that passage of an electrical current through the brain could lead to malfunction of implanted electrical devices, such as DBS and SCS. Alternatively, there was the postulated risk that exposure of a metallic DBS (or SCS) electrode to the electrical current delivered during ECT could cause heating of the electrode and damage surrounding brain tissue.…”

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

“…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.…”