An Unwanted Reduction of Seizure Duration During Electroconvulsive Therapy With Diltiazem.

To the Editor: W e write to report a case of transient bilateral parotid gland swelling after bilateral electroconvulsive therapy (ECT) treatment. Our patient is a 40-year-old white man with a history of schizoaffective disorder, childhood trauma, and alcohol use disorder in sustained remission, receiving ECT to augment clozapine for treatment refractory schizoaffective disorder. The patient's inpatient medications include clozapine, benztropine, magnesium citrate, diphenhydramine, and acetaminophen. He has received a total of 23 ECT treatments, now in a maintenance stage of treatment. The patient received methohexital 100 mg, succinylcholine 50 mg, and toradol 30 mg for anesthesia, consistent with previous treatments, and emergence was uneventful. The patient was treated with a MECTA spectrum model 5000Q, with bilateral lead placement; pulse width, 0.5 ms; frequency, 40 Hz; duration, 3 seconds; current, 800 mA; energy, 16 J; convulsion duration, 42 seconds; seizure duration, 49 seconds, with adequate seizure morphology. About 30 minutes after his 23rd treatment, the patient developed slightly tender, acute-onset, bilateral nonfluctuant submandibular swelling. There was no crepitation on palpation to suggest pneumoparotitis nor changes in overlying dermis to suggest an infectious process. Vitals signs were within normal limits, he was afebrile, and had no other systemic signs of infection nor dyspnea. Warm compresses were applied to both areas of swelling with good response and full resolution after an hour. Subsequently, he reported this response had occurred one other time prior after ECT, which resolved gradually after 24 hours.