Weiss Jacob R, Baker Lauren P
Department of Psychiatry and Behavioral Science, Temple University Hospital, Philadelphia, USA.
Department of Psychiatry, Virginia Commonwealth University, Richmond, USA.
Cureus. 2022 May 25;14(5):e25337. doi: 10.7759/cureus.25337. eCollection 2022 May.
There is limited literature on electroconvulsive therapy (ECT) in patients with a severe schizophrenia spectrum illness and concomitant seizure disorder. In addition, it is unclear whether it is safe to perform ECT in a patient with these comorbidities and a history of status epilepticus. This is the case of a 48-year-old patient with a history of schizoaffective disorder, bipolar type, refractory psychosis on clozapine and ECT, and seizure disorder on carbamazepine. She presented to the emergency department with suspected post-ECT delirium four days after her last ECT treatment, was found to be in non-convulsive status epilepticus, and was admitted to the neuroscience intensive care unit. Coma induction was required for seizure control. As she stabilized, her psychosis worsened, and she required psychiatric hospitalization. Multiple factors may have contributed to the development of status epilepticus in this patient. She was on clozapine, which has a time- and dose-dependent risk of seizure that prescribers should be wary of. She had also been prescribed the antiepileptic drug carbamazepine, which induces clozapine and itself, decreasing their effectiveness. Upon the patient's discharge, ECT was suspended indefinitely due to concern that it may have led to status epilepticus. However, case reports suggest that intractable seizures following ECT are rare. We found no reports of status epilepticus occurring more than 60 minutes after the completion of ECT. If the benefits of ECT are significant, then it should remain a treatment option for the patient.
关于电休克治疗（ECT）用于患有严重精神分裂症谱系疾病并伴有癫痫障碍的患者的文献有限。此外，对于患有这些合并症且有癫痫持续状态病史的患者进行ECT是否安全尚不清楚。本文报道了一名48岁的患者，有双相型精神分裂症病史，服用氯氮平及接受ECT治疗后出现难治性精神病，服用卡马西平治疗癫痫障碍。她在最后一次ECT治疗四天后因疑似ECT后谵妄就诊于急诊科，被发现处于非惊厥性癫痫持续状态，并被收入神经科学重症监护病房。为控制癫痫发作需要进行昏迷诱导。随着她病情稳定，其精神病症状加重，需要精神科住院治疗。多种因素可能导致了该患者癫痫持续状态的发生。她正在服用氯氮平，该药有时间和剂量依赖性的癫痫发作风险，开处方者应予以警惕。她还被开了抗癫痫药物卡马西平，该药物会诱导氯氮平及其自身代谢，降低它们的疗效。患者出院时，由于担心ECT可能导致癫痫持续状态，ECT被无限期暂停。然而，病例报告表明ECT后出现难治性癫痫发作的情况很少见。我们未发现有报告称在ECT完成后60分钟以上发生癫痫持续状态。如果ECT的益处显著，那么它仍应是该患者的一种治疗选择。
