ECT in the presence of brain tumor and increased intracranial pressure: evaluation and reduction of risk.
The presence of brain tumor and increased intracranial pressure has long been considered an absolute contraindication to electroconvulsive therapy. Recently, however, the American Psychiatric Association Task Force Report questioned the absolute nature of this contraindication and recommended a detailed evaluation of the risk-benefit ratio and measures to decrease the risks involved in treatment of affected persons. After a careful review, electroconvulsive therapy was administered to a 61-year-old patient who had severe medication-resistant major depression and a left temporal anaplastic astrocytoma with brain edema. Special attention was given to reduce intracranial pressure and minimize neurologic side effects. A course of eight nondominant unilateral electroconvulsive therapy treatments improved the depression significantly, without serious complications at the 4-month follow-up examination. With appropriate modifications, electroconvulsive therapy may be considered a treatment option even in the presence of clinical evidence of increased intracranial pressure. Further studies are needed to assess and minimize risks of electroconvulsive therapy in association with brain tumor.
Patkar
A A
AA
Department of Psychiatry and Human Behavior, Jefferson Medical College, Philadelphia, Pennsylvania, USA. patkar1@jeflin.tju.edu
Hill
K P
KP
Weinstein
S P
SP
Schwartz
S L
SL
D001254:Astrocytoma / Q000503:physiopathology*; D001929:Brain Edema / Q000503:physiopathology; D001932:Brain Neoplasms / Q000503:physiopathology*; D003865:Major Depressive Disorder / Q000503:physiopathology / Q000628:therapy*; D004292:Dominance, Cerebral / Q000502:physiology; D004565:Electroconvulsive Therapy; D006801:Humans; D007427:Intracranial Pressure / Q000502:physiology*; D008297:Male; D008875:Middle Aged; D009460:Neurologic Examination; D010348:Patient Care Team; D018570:Risk Assessment; D013702:Temporal Lobe / Q000503:physiopathology*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome