A case of atypical tardive seizure activity during an initial ECT titration series.

Electroconvulsive therapy (ECT) has been used in this country for more than 70 years, is still the most effective treatment in all of psychiatry, and is considered a very safe procedure to have under general anesthesia. Although most patients tolerate this procedure very well without complications, prolonged and/or tardive seizures or even status epilepticus can develop, which is a rare but serious complication of ECT. Tardive seizures are typically associated with electroencephalographic evidence of ictal activity and motor manifestations of the tonic-clonic activity. Whereas there are instances of nonconvulsive status epilepticus after ECT, this is the first report of a patient developing autonomic and motor manifestations of a tardive seizure without electroencephalographic evidence of seizure activity during the initial titration series to establish seizure threshold for a course of ECT.