Reversible Lacosamide Interference in Electroconvulsive Therapy: A Case Report

Ms. M is a 64-year-old female with a psychiatric history of schizoaffective disorder, bipolar type, and malignant catatonia, receiving biweekly maintenance electroconvulsive therapy (ECT). Her medical history includes hypertension, Parkinson’s disease, a reported seizure disorder, thyroid disease, hyperparathyroidism, gastroesophageal reflux disease, aortic valve replacement, and iron deficiency anemia. She was transferred to our academic tertiary care center from an outside hospital for ECT to treat presumed malignant catatonia. Psychoactive medications restarted at the time of her admission included carbidopa-levodopa 10–100 mg twice daily, lorazepam 2 mg by mouth every 8 hours, and lacosamide 200 mg twice daily. An EEG obtained at the outside hospital showed diffuse background slowing, consistent with mild global encephalopathy.