title: Safety of electroconvulsive therapy in the presence of cranial metallic objects.
abstract: OBJECTIVE
  Little is known regarding the safety of electroconvulsive therapy (ECT) in the presence of cranial metallic objects (cMO) such as medical devices or metallic foreign bodies. The presence of cMO raises 3 theoretical concerns toward the safety of ECT: (1) cMO may significantly alter the ECT-induced electric field distribution in the brain regarding field strength and focality, (2) vascular complications at the location of the cMO due to the ECT-induced hyperdynamic state may occur, and (3) possible development of a prolonged seizure/status epilepticus during ECT as a consequence of a device-induced symptomatic epilepsy. In the light of missing systematic approaches, we intended to assess the safety of ECT in the presence of cMO with particular regard to the concerns as specified previously.
  
  
  METHODS
  A systematic review of previously published cases of ECT in patients with cMO was conducted.
  
  
  RESULTS
  We identified 23 publications reporting 24 cases of ECT in the presence of cMO (cerebral clipping systems, 8 cases; cerebral coils, 2 cases; deep brain stimulator, 4 cases; osteosynthesis materials or other metallic medical devices, 7 cases; foreign bodies, 3 cases). Modified placement of ECT-electrodes was reported in 10 cases (42%). No ECT-related complications with regard to the proposed theoretical concerns were reported.
  
  
  CONCLUSIONS
  The absence of cMO-related complications during ECT in the reported cases implies that cMO might not represent an absolute contraindication for the performance of ECT. However, the indication for ECT should be put in place thoroughly in patients with cMO. Further research is necessary for an adequate safety assessment.
authors.affiliation: From the Department of Psychiatry and Psychotherapy III, University of Ulm, Ulm, Germany.
authors.forename: Maximilian
authors.initials: M
authors.lastname: Gahr
authors.forename: Bernhard J
authors.initials: BJ
authors.lastname: Connemann
authors.forename: Roland W
authors.initials: RW
authors.lastname: Freudenmann
authors.forename: Carlos
authors.initials: C
authors.lastname: Schönfeldt-Lecuona
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001860:Bone Plates; D000075202:Contraindications; D046690:Deep Brain Stimulation; D004565:Electroconvulsive Therapy / Q000009:adverse effects* / Q000379:methods; D004567:Electrodes, Implanted; D004574:Electromagnetic Fields; D005260:Female; D005547:Foreign Bodies / Q000150:complications*; D006801:Humans; D008297:Male; D008670:Metals; D008875:Middle Aged; D015607:Stents; D013525:Surgical Instruments; D055815:Young Adult
chemical_list: D008670:Metals