Fever After ECT: Report From Korea
Out on Pubmed, from investigators in Korea, is this paper:
Fever as a Side Effect after Electroconvulsive Therapy.
Neuropsychobiology. 2021 Jul 7:1-9. doi: 10.1159/000511542. Online ahead of print.PMID: 34233323
The abstract is copied below:
Background: Electroconvulsive therapy (ECT) is the most important and safe nonpharmacological treatment for psychiatric disorders. Some patients experience unexplained fever after ECT, but only a few studies have reported on this.
Method: We investigated fever after ECT by retrospectively reviewing the medical records of patients. Patients treated at the ECT unit of the Department of Psychiatry at Asan Medical Center, Seoul, South Korea, between 30 June 2004 and 30 June 2019, were included. Differences in variables were compared between groups with or without fever after ECT sessions.
Result: There were 28 patients (8.8%) in the fever group. Forty-three ECT sessions (1.5%) resulted in fever after treatment. The female-to-male ratio was higher in the fever group than in the control group, and the mean number of total ECT sessions was also higher in the fever group than in the control group, but there were no other differences between the 2 groups.
Conclusion: Comparing fever and control sessions, fever sessions relatively preceded control sessions and had a longer seizure duration. Postictal delirium occurred more often in the fever sessions than in control sessions. Fever sessions had a higher white blood cell count and lower concomitant quetiapine dosage than control sessions. Because 8.8% of patients who received ECT experienced fever after treatment more than once, fever after ECT is considered to be a common side effect.
Keywords: Electroconvulsive therapy; Fever; Side effect.
And from the text:
There were 319 patients (excluding minors) who received ECT at the Asan Medical Center between 30 June 2004 and 30 June 2019; 2,928 sessions of ECT were performed during this period. Forty patients (12.5%) and 75 sessions (2.6%) resulted in a fever of >38 °C within 24 h after ECT. However, there were no dropouts and noone refused further treatment among the patients who experienced fever after ECT. After excluding 12 patients who were diagnosed with infectious disease and other organic causes of fever, there were 28 patients (8.8%) in the fever group. Reasons for exclusion were: 2 patients each had autoimmune encephalitis, neuroleptic malignant syndrome, pneumonia, rhabdomyolysis, or urinary tract infection, 1 patient had sinusitis, and 1 had an unspecified viral infection. There were 43 fever sessions, accounting for 1.5% of all sessions and 12.5% of the sessions in the fever group. The mean number of fever sessions in the fever group was 1.54 ± 1.07. The control group that never had fever (including a low-grade fever of 37 or 38 °C) comprised 37 patients. Twenty-two patients were diagnosed with major depressive disorder, followed by 5 with bipolar disorder, 5 with schizophrenia, 3 with idiopathic Parkinson’s disease, 1 with obsessive-compulsive disorder, and 1 with a somatic symptom disorder.
Approximately 8.8% of patients who received ECT had fever more than once, and 1.5% of all individual ECT sessions caused fever. This prevalence was higher than that of other side effects such as dizziness and nausea [29]. Moreover, the rate increased to 12.5% when the sessions involved the fever group only. If patients experienced fever after ECT, it was more likely that they would have another fever event thereafter. Thus, we believe that fever after ECT could be a more common side effect than previously acknowledged. Because we excluded fever caused by general medical conditions (including infectious disease) as much as possible, the rate of 8.8% is noteworthy. In fact, all patients in this study who experienced fever after ECT did not have any other symptoms, except febrile sense, which means that the fever was unlikely to be caused by general medical condition.
Approximately 8.8% of patients who received ECT had fever more than once, and 1.5% of all individual ECT sessions caused fever. This prevalence was higher than that of other side effects such as dizziness and nausea [29]. Moreover, the rate increased to 12.5% when the sessions involved the fever group only. If patients experienced fever after ECT, it was more likely that they would have another fever event thereafter. Thus, we believe that fever after ECT could be a more common side effect than previously acknowledged. Because we excluded fever caused by general medical conditions (including infectious disease) as much as possible, the rate of 8.8% is noteworthy. In fact, all patients in this study who experienced fever after ECT did not have any other symptoms, except febrile sense, which means that the fever was unlikely to be caused by general medical condition.This is an interesting retrospective chart review that documents the prevalence of fever after ECT and looks at potential correlates. Notably, obvious causes of fever were excluded. Longer seizures and greater likelihood of delirium were seen in the ECT sessions followed by fever.
I think the "fever session" metric of 1.5% is the most relevant number- thus, I would still call it a rare event, even though the authors' main point is that it may be more common than generally believed.
For students of ECT anesthesia and ECT technique, this paper merits a full read, ~15 minutes.
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