Safe ECT in a Patient with an Astrocytoma: Case Report
Out on PubMed, from researchers at the Medical College of Georgia at Augusta University, is this case report:
Safe Administration of ECT in a Suicidal Patient With a Space-Occupying Astrocytoma.
J ECT. 2021 Feb 19. doi: 10.1097/YCT.0000000000000749. Online ahead of print.PMID: 33625177
The abstract is copied below:
Electroconvulsive therapy (ECT) can be lifesaving for patients suffering from treatment-resistant psychiatric conditions, especially acute suicidality or depression. However, space-occupying lesions pose risks associated with ECT use due in part to seizure-induced escalations in blood pressure with corresponding increases in cerebral blood flow and possibly intracranial pressure, subsequently increasing the risk of brain herniation. Here, we present the case of a patient with a left medial temporal lobe astrocytoma, worsening epileptic seizures, and nonepileptic seizures who underwent ECT for major depressive disorder and suicidality. The patient had improvement of depressive symptoms, resolution of suicidality, and brief cessation of nonepileptic seizures. Brief anterograde amnesia contributed to the termination of treatment. This case adds to the growing literature about the feasibility of ECT treatment in cerebral lesions prone to changes in intracranial pressure, such as the usually cystic astrocytomas.
This case report adds to the evidence base of the safety of ECT in presence of a brain tumor not associated with increased intracranial pressure, edema or mass effect. Esmolol was used to control blood pressure; at the second treatment, a prolonged seizure was terminated with additional methohexital. The literature on ECT and brain tumors is briefly reviewed, constrained by the limit of 5 references.
Practitioners will want to read this case report in full (~10 minutes) to review procedural recommendations for management of this clinical situation.
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