Spontaneous Seizure From Remifentanil Induction During Electroconvulsive Therapy.

temperature change, studies have demonstrated the energy used in ECT to be too low to cause significant heating of metallic plates, especially titanium (the material used in most neurosurgical implants at this time), which is principally inert. In addition, given the exponential fall in total energy with increasing distance, lead placement that maximizes distance from the intracranial objects further decreases theoretical risk of heat and current shunting. We therefore suggest that in patients with intracranial objects and comorbid seizure disorders, antiepileptics should be safely minimized to limit energy delivered and intracranial objects be clearly located to optimally adjust lead placement. Although there have been previously published cases of successful ECT treatment with intracranial metallic objects and comorbid epilepsy, this is the first, to our knowledge, to document safe treatment with ECTwith titanium mesh in the posterior fossa.