Tardive Seizures After ECT: New Literature Review

Out on PubMed, from investigators in Australia, is this literature review:

Tardive Seizures After Electroconvulsive Therapy.

Warren N, Eyre-Watt B, Pearson E, O'Gorman C, Watson E, Lie D, Siskind D.J ECT. 2022 Jan 28. doi: 10.1097/YCT.0000000000000821. Online ahead of print.PMID: 35093969

The abstract is copied below:

Objectives: Seizures that occur spontaneously after termination of an electroconvulsive therapy (ECT) seizure are termed tardive seizures. They are thought to be a rare complication of ECT, influenced by risk factors that affect seizure threshold. However, there has been limited review of tardive seizures with modified ECT. We aimed to review the literature to provide clinical guidance for the use of ECT after tardive seizures.

Methods: PubMed, EMBASE, PsycInfo, and CINAHL databases were searched from inception to May 2021 to identify cases of modified ECT, with evidence of a seizure occurring within 7 days of a terminated ECT seizure. Data for demographic, medical, pharmacological, anesthetic, and ECT variables as well as management strategies were collected.

Results: There have been 39 episodes of modified ECT-related tardive seizures published over a period of 40 years. In 97.4% of cases, there was at least 1 identified potential risk factor for seizures, including use of a seizure-lowering medication and/or preexisting neurological injury. Major complications were uncommon (<15% of cases); however, 1 fetal death and 1 subsequent suicide were reported. No case was diagnosed with epilepsy, although around 20% continued on antiepileptic medications. More than half of the included patients were retrialed on ECT, with only 15% developing further tardive seizures.

Conclusions: Seizures that occurred spontaneously after the termination of an ECT seizure are a rare complication of modified ECT. Recommencing ECT after a tardive seizure may occur after review of modifiable seizure risk factors and with consideration of antiepileptic medication and extended post-ECT monitoring.

The article is here.

And from the text:

and later:        ...

This is an excellent and comprehensive review of the literature on tardive seizures after ECT. It gets most things correct, and is a very useful reminder to ECT practitioners about this rare and potentially very serious complication. In suggestions to prevent recurrence of tardive seizures, the authors list decreasing stimulus charge; we know that this is incorrect, actually the opposite of what should be done (see the Luccarelli et al. Harvard data...). They also incorrectly report from the Van Waarde review of 2009 that BT electrode placement has the lowest seizure threshold, when, in fact, it is RUL. These minor points aside, this is well worth reading for all ECT practitioners, ~15 minutes.