Gralewicz Anna, Świȩcicki Łukasz, Antosik-Wójcińska Anna Z, Konopko Magdalena, Kurkowska-Jastrzȩbska Iwona, Sienkiewicz-Jarosz Halina, Szostakiewicz Łukasz, Remberk Barbara
Child and Adolescent Psychiatry Department, Institute of Psychiatry and Neurology (IPiN), Warsaw, Poland.
Second Psychiatry Department, Institute of Psychiatry and Neurology (IPiN), Warsaw, Poland.
Front Psychiatry. 2021 Nov 12;12:646466. doi: 10.3389/fpsyt.2021.646466. eCollection 2021.
Electroconvulsive therapy (ECT) has been recognized as an effective treatment option in catatonia, and for prolonged or severe affective episodes and schizophrenia. Response rates vary from 40 to 80% in adolescents. The procedure is safe if the required precautions are undertaken. Nonetheless, ECT remains a serious clinical challenge in patients with comorbid seizures. We present a case study of a 17-year-old female student suffering from schizophrenia who was scheduled for ECT due to prior treatment inefficacy. Seizures had occurred a few days before the first ECT session. Nevertheless, the patient received the ECT course, combined with clozapine at 125 mg/day, after neurological diagnosis and treatment modification because the illness became life-threatening. The patient's clinical outcome was satisfactory without any seriously adverse events and further improvements were observed in the mental state following long-term psychosocial treatment at our inpatient unit. A few months later, epilepsy was however diagnosed with probably coexistence of partial seizures and seizure-like events without EEG correlate. Administering ECT in patients with seizure comorbidity was also investigated based on previous research. Data on this is, however, extremely scarce and to the best of our knowledge, the safety and efficacy of using ECT in adolescents with schizophrenia and seizures has yet not to any great extent been discussed in the literature.
电休克治疗（ECT）已被公认为是治疗紧张症、持续性或严重情感发作以及精神分裂症的一种有效治疗选择。青少年的有效率在40%至80%之间。如果采取了必要的预防措施，该治疗方法是安全的。尽管如此，对于合并癫痫的患者，ECT仍然是一项严峻的临床挑战。我们报告一例17岁患精神分裂症的女学生病例，因其先前治疗无效而计划接受ECT治疗。在首次ECT治疗前几天患者出现了癫痫发作。然而，由于病情危及生命，在进行神经学诊断并调整治疗方案后，患者接受了ECT疗程，并联合使用125毫克/天的氯氮平。患者的临床结果令人满意，没有出现任何严重不良事件，并且在我们住院部进行长期心理社会治疗后，其精神状态有了进一步改善。然而，几个月后，患者被诊断出患有癫痫，可能并存部分性发作和无脑电图相关性的癫痫样发作。基于先前的研究，也对合并癫痫的患者进行ECT治疗进行了调查。然而，关于这方面的数据极其稀少，据我们所知，文献中尚未对在患有精神分裂症和癫痫的青少年中使用ECT的安全性和有效性进行过广泛讨论。
