Monitoring Intracranial Pressure Change Through Optic Nerve Sheath Ultrasound During Electroconvulsive Therapy.

Abstract

Objectives: Electroconvulsive therapy (ECT), which is applied by producing a seizure with an electrical current under general anesthesia, is an effective and reliable method in the treatment of most psychiatric diseases. Nevertheless, how the treatment affects intracranial pressure and other neuronal mechanisms is uncertain. This prospective observational study evaluated the effects of ECT on intracranial pressure by measuring the optic nerve sheath diameter (ONSD) using ultrasonography.

Methods: Thirty-nine patients undergoing their first ECT session were included in the study, and ONSD measurements were performed on all patients at 4 time points: before and after anesthesia induction, after ECT (post-ictal), and during the recovery phase. Age, weight, height, psychiatric diagnoses, medications and comorbidities, blood pressure and heart rate values, and motor seizure durations were recorded.

Results: Post-ictal ONSD (5.47 ± 0.40 mm) was significantly higher than preinduction (4.89 ± 0.33 mm), postinduction (4.90 ± 0.35 mm), and recovery (4.96 ± 0.38 mm) measurements (P < 0.001). The change in ONSD during ECT was significantly higher in patients with preexisting hypertension (P = 0.001) and correlated positively with blood pressure.

Conclusions: In patients with an indication for ECT and without an intracranial space-occupying lesion, ECT procedure may cause a transient increase in intracranial pressure (ICP). This change in ICP may be more pronounced in patients with a diagnosis of hypertension. These findings highlight the need for careful monitoring of ICP in hypertensive patients undergoing ECT.