Is Routine Brain Imagiing Necessary Before Electroconvulsive Therapy?

Electroconvulsive Therapy (ECT) is a treatment method that creates controlled seizures by applying electrical current stimulation to the brain. Although there are no absolute contraindications for ECT, routine brain imaging is often performed before ECT. The aim of this study is to determine the prevalence of incidental abnormalities that may preclude the use of ECT through routine cross sectional brain imaging. The medical records of all patients who underwent ECT between January 2010 and June 2021 were reviewed retrospectively. We examined the results of their routine neurological evaluations and any brain imaging reports. In addition, the patient’s sociodemographic characteristics, such as age and gender, and any reports of unexpected complications that arose from the ECT were examined. A total number of 156 patients who underwent ECT between the dates were examined, of which 113 patients had brain imaging (CT:58, MRI:51, Diffusion MRI:4) performed prior to ECT. The rate of normal findings was 47% in MRI, 86% in CT, and 100% in diffusion MRI. There was no findings that prevented ECT from being performed, and no report that showed increased intracranial pressure, and none of the patients developed an unexpected intracranial complication from ECT. Our results show that routine neuroimaging before ECT is not required. In the clinical examination, we recommend brain imaging before ECT only if there is a suspicion of intracranial pathology and examination findings that indicate this.

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1. UK ECT Review Group. Efficacy and safety of electroconvulsive therapy in depressive disorders: a systematic review and meta-analysis. Lancet 2003;361(9360):799-808.
2. Leiknes KA, Jarosh-von Schweder L, Høie B. Contemporary use and practice of electroconvulsive therapy worldwide. Brain Behav 2012;2(3):283-344.
3. Gaines GY, Rees DI. Electroconvulsive therapy and anesthetic considerations. Anesth Analg 1986;65(12):1345-1356.
4. Tess A V, Smetana GW. Medical evaluation of patients undergoing electroconvulsive therapy. N Engl J Med 2009; 2;360(14):1437-44.
5. Gassel MM. Deterioration after electroconvulsive therapy in patients with intracranial meningioma. Arch Gen Psychiatry 1960;3:504-506.
6. Maltbie AA, Wingfield MS, Volow MR, Weiner RD, Sullivan JL, Cavenar JOJ. Electroconvulsive therapy in the presence of brain tumor. Case reports and an evaluation of risk. J Nerv Ment Dis 1980;168(7):400-405.
7. American Psychiatric Association. The practice of electroconvulsive therapy: recommendations for treatment, training, and privileging. Washington, District of Columbia; 2001.
8. Narang P, Swenson A, Lippmann S. Neuroimaging Before ECT? J ECT 2019;35(1):e5- e6.
9. Sajedi PI, Mitchell J, Herskovits EH, Raghavan P. Routine cross-sectional head ımaging before electroconvulsive therapy: a tertiary center experience. J Am Coll Radiol 2016;13(4):429-434.
10. Reddy MS. Electro-convulsive Therapy: A Few Lingering Thoughts/Doubts! Indian Journal of Psychological Medicine Indian J Psychol Med 2011;33(2):103-105.
11. Bulbul F, Demir B, Aksoy İ, Alpak G, Unal A, Savas H. Electroconvulsive therapy in a major depression patient with arachnoid cyst. Dusunen Adam 2013;26(4).
12. Buday J, Albrecht J, Mareš T, Podgorná G, Horáčková K, Kališová L, et al. Brain tumors and electroconvulsive therapy: a literature overview of the last 80 years. Front Neurol 2020;11:723.
13. Youssef NA, Casola B, Rosenquist PB, McCall W V, Spearman V. Safe administration of ECT in a suicidal patient with a space-occupying astrocytoma. J ECT 2021;37(3):207-208.
14. Desseilles M, Thiry J-C, Monville J-F, Ansseau M, Makhinson M. Electroconvulsive therapy for depression in a patient with an intracranial arachnoid cyst. J ECT 2009;25(1):64–6.
15. Rasmussen KG, Perry CL, Sutor B, Moore KM. ECT in patients with intracranial masses. J Neuropsychiatry Clin Neurosci 2007;19(2):191- 193.
16. Thukral-Mahajan P, Shah N, Kalra G, Andrade C. Electroconvulsive therapy for medication refractory depression in a patient with ruptured intracranial dermoid cyst, meningioma, and neurofibromatosis. Indian J Psychiatry 2017;59(4):493-495.
17. Kellner CH, Rames LJ. Case report: Dexamethasone pretreatment for ECT in an elderly patient with meningioma. Clinical gerontologist 1991;10(2):67–72.
18. Kellner CH. Towards the modal ECT treatment. J ECT 2001;17(1):1-2.
19. Kellner CH. The CT scan (or MRI) before ECT: a wonderful test has been overused. Convuls Ther 1996;12(2):79-80.
20. Eskandary H, Sabba M, Khajehpour F, Eskandari M. Incidental findings in brain computed tomography scans of 3000 head trauma patients. Surg Neurol 2005;63(6):550-553.
21. Barrett TW, Schierling M, Zhou C, Colfax JD, Russ S, Conatser P, et al. Prevalence of incidental findings in trauma patients detected by computed tomography imaging. Am J Emerg Med 2009;27(4):428-435.