In my last post I looked at the high use of electroconvulsive therapy (ECT) in Victoria, Australia, and in particular its high use on people without their consent. Last year an article published in the journal Epilepsia provided a glimpse of the use of ECT in Victoria. The article, “Temporal lobe epilepsy following maintenance electroconvulsive therapy – electrical kindling in the human brain“, by A. Bryson et al., looked at five people who developed temporal lobe epilepsy while they were undergoing maintenance ECT.
All five patients were described as having been referred for neurological assessment after experiencing “unusual events”: patient 1 had blank spells lasting up to 20 seconds; patient 2 had cognitive and memory problems; patient 3 lost awareness for 2 or 3 minutes; patient 4 had confusion and psychomotor slowing; patient 5 had a deterioration in cognition. I am actually quite surprised that such events would be picked up and be of enough concern to warrant a referral to a neurologist (after all, a lot of people experience cognitive and memory problems with ECT and they are generally not taken very seriously) and I am left wondering if perhaps the neurologists who wrote the article were actively recruiting ECT patients for their research.
Three of the four authors are affiliated to Austin Hospital, Melbourne, Victoria; the fourth to a Queensland Hospital. It is not clear whether all five patients were having ECT in Victoria, and no information is given about the time scale over which the referrals took place.
The patients (three men and two women) ranged in age from 31 to 81 and had had 873 electroconvulsive treatments between them. Four were having bilateral ECT, one had had a combination of bilateral and unilateral. All the patients were also taking drugs and were described as having a treatment-resistant disorder (schizophrenia, depression or schizo-affective disorder) but no information was given about how treatment resistance was defined.
Patient 1 for example was a 39-year-old woman with a diagnosis of schizophrenia who had been given 106 bilateral treatments over the past year. Now, in the UK, where treatment is usually given twice a week, that would represent a continuous course of ECT lasting over a year, rather than maintenance ECT. Even if, as the article says, she was sometimes having ECT three times a week, it still means that the maintenance treatments must have been very closely spaced. After neurological assessment revealed epileptiform abnormalities her treatments were reduced to once a week. The other four patients had their ECT stopped after neurological assessment. It was patient 5, a 59-year-old man who who had had the most ECT, 348 treatments over 7 years. His ECT was stopped after he had a generalised convulsion.
The authors of the article conclude: “These patients suggest that maintenance ECT is potentially hazardous”. The article did not look at how these people had come to have such large numbers of treatments, or how they fared (apart from their EEGs) after their treatment was stopped.