Raised Intracranial Pressure in Seizures Induced by ECT: Optic Nerve Sheath Diameter as ICP Proxy

 Out on PubMed, from authors in the Netherlands, Belgium, and Germany, is this study:

Raised Intracranial Pressure in Seizures Induced by Electroconvulsive Therapy.

Spoor JKH, Hollestelle RVA, Birkenhager TK, De Wit MY, Haitsma IK, Mathijssen IMJ, van Veelen MC, Kamp MA, Pluijms E, Klimek M, Neuteboom R, Maissan I, Dibué M.Eur J Neurol. 2025 Apr;32(4):e70149. doi: 10.1111/ene.70149.PMID: 40237234

The abstract is copied below:

Background: Increased intracranial pressure (ICP) can be observed immediately upon seizure activity in craniotomized patients in neurosurgical practice. However, it is not commonly included in models of pathomechanisms contributing to morbidity and mortality in epilepsy. A main contributor to this may be the fact that measuring ICP noninvasively during a seizure is technically challenging. The optic nerve sheath diameter (ONSD) represents a promising, noninvasive option to monitor relative ICP changes. We therefore measured ONSD in patients undergoing electroconvulsive therapy (ECT).

Methods: Twenty-seven ECT-induced seizures from nine consecutive patients underwent ONSD measurement at baseline after induction of anesthesia (t0), during injection of suxamethonium (sux) (t1), after injection of sux (t2), during the electrically induced seizure (t3), and after the electrically induced seizure (t4). A linear mixed model was applied.

Results: An increase in ONSD of > 0.2 mm from t0 to t3 was observed in all patients and in all ECT-induced seizures except one. ONSD increased significantly during the succinylcholine-induced fasciculations, T1, (β = 0.535 mm, p < 0.001) and during the electrically induced seizure, T3, (β = 1.02 mm, p < 0.001). ONSD returned to baseline after the fasciculations, T2, (β = 0.091 mm, p = 0.443) and after the seizure, T4, (β = 0.103 mm, p = 0.379).

Conclusions: This investigation shows generalized convulsive seizures are associated with a transient but pronounced increase in ONSD, suggesting a temporary increase in ICP.

Keywords: depression; epilepsy; intracranial pressure; raised ICP; seizure.

The paper is here.

And from the text:

Here is a very nice little study confirming what is generally accepted knowledge, that intracranial pressure goes up transiently with an ECT-induced seizure. What is particularly innovative is the use of ultrasound to measure the diameter of the optic nerve sheath as a proxy for ICP. The other interesting finding is the increase of ICP with fasciculations from succinylcholine.

It is published in a neurology journal, so hopefully it will impart some ECT knowledge to a wider audience.

Kudos to our European colleagues.