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Ask the Experts

Question:

If somebody has epilepsy, is it still possible to have ECT when all other treatments have failed for depression?

Answered by: Joan Prudic

Yes, ECT can be given under these circumstances. When a psychiatric condition is being treated with ECT in an epileptic patient, antiepileptic medications are continued during the treatment course, since there is a concern about increased risk for prolonged or spontaneous seizures during the treatment course.

The use of anticonvulsant medications, even under such circumstances, could, theoretically, complicate treatment by increasing seizure threshold and/or diminishing seizure expression and, possibly, decrease response of the psychiatric condition to ECT.

Hence, dosage of anticonvulsant medications should be kept as low as possible in consultation with a neurologist managing the seizure disorder.

It is not well know but ECT has marked anticonvulsant properties and has been reported as a treatment for seizure disorder itself, since the 1940s.

More recently, there have been reports of possible value in the management of intractable epilepsy and status epilepticus, particularly.