Effect of Electroconvulsive Therapy on Intracranial Pressure: An Evaluation Using Optic Nerve Sheath Diameter Measurements.

Abstract

Objectives: Electroconvulsive therapy (ECT) stands as a widely acknowledged and effective treatment modality for a range of psychiatric disorders but requires careful patient selection and monitoring to ensure safety in the presence of risk factors given the pronounced physiologic response to the treatment and its attendant generalized anesthesia. Although there is substantial evidence indicating that ECT may trigger an increase in intracranial pressure (ICP) under specific patient circumstances, no studies demonstrate the degree of ICP changes associated with routine clinical ECT. Ultrasonographic measurement of the optic nerve sheath diameter (ONSD) provides an indirect measure of intracranial pressure.

Methods: We conducted serial ONSD assessments in 24 patients at four pivotal junctures during ECT treatment: pre-ECT administration, postanesthesia induction, immediate postictal seizure, and postanesthesia recovery. The ONSD measurements were analyzed with a two-way analysis of variance (ANOVA).

Results: We found no statistically significant discrepancies in ONSD measurements compared to baseline readings at any of the post-ECT time points. In addition, there was no difference in ONSD changes between patients who did or did not receive esmolol during treatment or underwent ECT with either unilateral or bilateral electrode placement.

Conclusions: These findings strongly suggest that ECT does not induce substantial alterations in intracranial pressure, as determined through ONSD ultrasonography. Nevertheless, it is imperative to underscore the necessity for further research encompassing larger patient cohorts and those who may have baseline elevations of ICP.