Cochlear Implants and ECT

Out on PubMed, from investigators in Denmark, is this letter-to-the-editor:

Cochlear Implant Should not be Absolute Contraindication for Electroconvulsive Therapy and Transcranial Magnetic Stimulation.

Reveles Jensen KH, Navntoft CA, Sindahl CH, Cayé-Thomasen P, Jørgensen MB.Brain Stimul. 2020 Aug 12:S1935-861X(20)30225-4. doi: 10.1016/j.brs.2020.08.007. Online ahead of print.PMID: 32800965 
The text portion of the letter about ECT is copied here:

Cochlear Implants [CIs] and ECT

There are no absolute contraindications for ECT treatment, but in practice, a CI is considered one4. The literature on ECT and CI safety is limited to a study on cadaver heads and two case reports.

Ten CIs (Nucleus CI512/N5) were implanted in fresh human cadaveric heads and administered 12 ECT sessions with maximum full pulse-width energy (576mC, 800mA, 1.0ms pulse width, 60Hz, 6s duration). Half received ECT contralateral to the CI and the other half ipsilateral. Impedance measurements before, in between, and after ECT showed no damage to the electrodes. There was no statistically significant difference in impedance values between ipsilateral and contralateral ECT. Further testing by the manufacturer did not show any electrical damage4.

A 17-year-old male CI-user (Nucleus 22) received two en-bloc contralateral ECT treatments (48mC, 800mA, 9.9J, 1ms pulse width, 40Hz, 0.75s) on vital indication due to manic delirium; later subjective and objective assessment of the CI showed no dysfunction5. The CI was replaced four months later due to pain at the site of the external processor, and examination of the CI revealed it was not a fault related to the ECT4.

A 78-year-old female CI-user (Nucleus CI24RE) received on vital indication 13 contralateral ECT treatments (up to 1004mC, 900mA) due to severe psychotic depression and refusal of medicine, food, and fluids. The treatments had no complications, and no CI damage was observed in the following control6. The studies used treatments with 80-100% of the maximal stimulus (1008mC)4, 5, 6.

This LTE is a literature review (no new cases). In their discussion, the authors state that the experience with ECT and CIs is in 135 procedures, 120 of which were in the cadaver experiment, so the actual reported experience is still just 2 patients (15 treatments total). Nonetheless, their message of carefully weighing the risks and benefits of ECT in patients with CIs, rather than categorically considering this a contraindication to ECT (or TMS) is a very useful one.

 

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