ECT For Children at a University Hospital: New Study in JECT

 Out on PubMed, from authors at Vanderbilt and Mass General,, is this article:

Use of ECT for Children With and Without Catatonia: A Single-Site Retrospective Analysis.

Smith JR, Baldwin I, Termini KA, McGonigle T, Vandekar S, Luccarelli J.J ECT. 2024 Jan 25. doi: 10.1097/YCT.0000000000000993. Online ahead of print.PMID: 38265759

The abstract is copied below:

Objectives: The objective study was to investigate the safety and efficacy of electroconvulsive therapy (ECT) in a retrospective cohort of pediatric patients.

Methods: A single-site retrospective analysis was conducted of patients aged younger than 18 years who received ECT in a private university hospital from January 28, 2012 to April 8, 2023. Treatment efficacy and adverse events were determined retrospectively through review of the medical record.

Results: A total of 36 pediatric patients met the inclusion criteria. Catatonia was the most common presenting indication for ECT, followed by psychosis and suicidal ideation. For all patients, Clinical Global Impressions-Improvement scale scores indicated that it was very likely for a subject to experience at least "much improvement" with the estimated probability of receiving a Clinical Global Impressions-Improvement scale score better than 3 of 0.852 (t.s. = 16.3; P < 0.001; 95% confidence interval, 0.711-0.931). All patients with catatonia demonstrated a positive clinical response and experienced a statistically significant reduction in total Bush-Francis Catatonia Rating Scale scores observed (t = 11.9; df = 20; SD = 6.3; P < 0.001; 95% confidence interval, 12.6-17.9). No significant adverse events were reported for any patient in the cohort. However, 14 (38.9%) patients experienced prolonged seizures, all of which were terminated with propofol (mean, 49.7 mg).

Conclusions: This study provides further data supporting the safe and effective use of pediatric ECT in the treatment of various psychiatric conditions. However, more research is needed to determine the risk factors associated with prolonged seizures and the optimal seizure parameters in young people.

The article is here.

And from the text:

This retrospective study adds important data to the ECT literature about the safe and effective use of ECT in children. The bureaucratic delay in initiation of ECT due to restrictive legislation is noteworthy and troubling.

The authors note prolonged seizure (definition here 2 minutes, not the 3 minute APA definition) in ~6% of treatments. IMO, practitioners should anticipate prolonged seizures in young patients and have protocols in place to intervene quickly, getting ready by about 90-100 seconds. And if it happens once in a patient, it should be anticipated at subsequent treatments. It would be interesting to know if any of the prolonged seizures occurred in patients on bz/flumazenil.

Kudos to these authors for this this very useful contribution the pediatric ECT literature.