title: Is electroconvulsive therapy safe in the presence of an intracranial metallic object?: case report and review of the literature.
abstract: BACKGROUND
  Little is known about the use of electroconvulsive therapy (ECT) in patients with intracranial metallic objects. Theoretically, electric current might cause heating of the metal and damage of the surrounding brain tissue. Moreover, intracranial foreign objects increase the risk for epileptic phenomena and could thus complicate the treatment course.
  
  
  METHODS
  The case of a man with intracranial bullet fragments as a result of a headshot, treated with ECT for mania, is presented. We conducted a PubMed literature search for other relevant cases.
  
  
  RESULTS
  In our patient, ECT was completed without complication. Electroconvulsive therapy was safely administered in 22 published cases of patients with intracranial metallic objects.
  
  
  CONCLUSIONS
  After carefully weighing benefits and risks in each individual case, psychiatrists should not be reluctant to use ECT in patients with intracranial metallic objects. Apart from avoiding empirical dosage titration to minimize the exposure to current, positioning the electrodes to avoid the electric current of heating the metal, and continuing antiepileptic agents in high-risk patients, no precautions need to be considered.
authors.affiliation: ECT Department, University Psychiatric Center, Catholic University Leuven, Campus Kortenberg, Kortenberg, Belgium. philippe.mortier@uzleuven.be
authors.forename: Philippe
authors.initials: P
authors.lastname: Mortier
authors.forename: Pascal
authors.initials: P
authors.lastname: Sienaert
authors.forename: Filip
authors.initials: F
authors.lastname: Bouckaert
mesh_terms: D001714:Bipolar Disorder / Q000523:psychology / Q000628:therapy; D004565:Electroconvulsive Therapy / Q000009:adverse effects* / Q000379:methods; D005260:Female; D006801:Humans; D007854:Lead; D008279:Magnetic Resonance Imaging; D008670:Metals; D008875:Middle Aged; D011595:Psychomotor Agitation / Q000523:psychology / Q000628:therapy; D011618:Psychotic Disorders / Q000150:complications / Q000523:psychology; D013406:Suicide, Attempted; D014057:Tomography, X-Ray Computed; D014948:Wounds, Gunshot / Q000150:complications*
chemical_list: D008670:Metals; D007854:Lead