New Focal Epileptogenesis Following Electroconvulsive Therapy: A Case Report and Literature Review

In this case report, a patient developed new focal epileptiform discharges following electroconvulsive therapy (ECT). No current evidence to date has established an increased risk of epilepsy following ECT, raising the question of ECT potentially triggering focal epileptogenesis. To address this question, literature findings from epidemiologic studies to isolated case reports were compiled from PubMed with an emphasis on patient risk factors, number of treatments, and described electroencephalographic patterns and seizure semiology post-ECT. The relationship between ECT and new-onset epilepsy remains controversial based on these findings. Two retrospective epidemiologic surveys of patients treated with ECT could not demonstrate an increased risk of ECT-induced epilepsy when accounting for individual risk factors. However, newer isolated case reports have described patients on maintenance ECT who then developed definite or possible epilepsy. In some of these cases, patients who received bitemporal electrode placement then developed temporal lobe epilepsy. Previous animal model studies suggest a form of electrical kindling that may explain epileptogenesis. The compiled findings suggest that ECT may trigger focal epileptogenesis in some patients, particularly those with bitemporal electrode placement. Health care providers should be aware of this potential risk and carefully evaluate patients before recommending ECT.