CSF Metabolomics, ECT, and Delirium-True, True, Related?

Out on PubMed is this case report:Cerebrospinal fluid metabolomics uniquely identifies pathways suggesting risk for anesthesia reactions during electroconvulsive therapy for bipolar disorder.

Berner J, Elsea S.Bipolar Disord. 2020 Aug 13. doi: 10.1111/bdi.12982. Online ahead of print.PMID: 32794310

The abstract is copied here:

In this case report, we describe the results of next generation non‐targeted cerebrospinal spinal fluid (CSF) metabolomics in a patient presenting with a prolonged delirium and elevated serum ammonia after standard electroconvulsive therapy treatment. These studies subsequently, in part, revealed abnormalities in the citric acid cycle, a finding previously reported in the bipolar literature. The patient subsequently has had a sustained response to pioglitazone, a mitochondrially targeted agent, in contrast to established medical and interventional therapies.

And from the text:

Observed isocitrate elevation likely corresponds to bipolar disorder phenotype [sic]...

In summary, this case raises the possibility that a novel biopsy, untargeted CSF metabolomics, has the potential to identify useful individual biochemical signatures in patients with unusual responses to standard treatments.

This is a sparsely detailed case report of a young woman with bipolar disorder who had delirium after her 5th ECT. It certainly seems possible that a simpler explanation for her delirium was the prolonged seizure. That she later was diagnosed with a genetic mitochondrial disorder may, or may not, be related.

In my opinion, this is a report of a not-uncommon adverse effect looking for a rare, arcane biochemical explanation.

I do, however, like the term, "novel biopsy," in reference to a spinal fluid analysis.