Transient Neurological Deficit with ECT in a Patient on Lithium: Case Report From China

Out on PubMed, from clinicians in China, is this case report:

Electroconvulsive therapy combined with lithium developed reversible pure anomic aphasia: a case report.

Yang Q, Cheng X, Su Z, Sun L, Li M.BMC Psychiatry. 2022 Oct 27;22(1):663. doi: 10.1186/s12888-022-04323-1.PMID: 36303177

The abstract is copied below:

Background: Electroconvulsive therapy (ECT) combined with mood stabilizers is an effective method of treatment for manic episodes; however, there are controversial views on its side effects.

Case presentation: A 53-year-old man was diagnosed with bipolar disorder during a manic episode, and had previous conditions such as hypertension, and diabetes. He developed reversible delirium and anomic aphasia during combined treatment with lithium and ECT (Li-ECT). No other neurological symptoms or signs happened during the one-month follow-up period.

Conclusions: The anomic aphasia appeared after ECT was reversible. Li-ECT should be administered with caution to middle- and older-aged patients with comorbidities, and serum Li levels should be closely monitored during the treatment period.

Keywords: Bipolar disorder; Case report; Electroconvulsive therapy; Lithium; Pure anomic aphasia.

The pdf is here.

And from the text:


I would not put too much store in this one.
The authors had a cavalier attitude towards ECT with lithium levels of 1.2 meq/L, ignoring common guidelines to withhold doses for 24 hours. Furthermore, the connection between the transient anomic aphasia and lithium is tenuous, at best. The lithium may have had nothing to do with it, in a patient with hypertension and diabetes getting high-dose bilateral ECT...
In any case, a very rare complication that is instructive to know about, but this report does not change standard, careful practice.

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