Half a Century of ECT Use in Young People

by Joseph M. Rey and Garry Walter
American Journal of Psychiatry 154:5, May 1997

Here are some chilling excerpts from a recent article which irresponsibly sanitizes the many catastrophic and permanent effects of electroshock on children such as epileptic seizures, permanent memory loss ("subjective memory loss"),intellectual disabilities, and brain damage ("organic brain syndrome"). More alarming, some children were already brain-damaged when subjected to shock!

ADVERSE EVENTS

A young 16-year-old girl with neuroleptic malignant syndrome and a stuperous state had eight ECTs without improvement. She died of cardiac failure 10 days after the last treatment. Her death is likely to have been due to the continued administration of neuroleptic medication in spite of her neuroleptic malignant syndrome.

..Bauer noted the case of a 15-year-old girl with schizophrenia who received 200 ECTs in 1 year. Heuyer et al. described a 16-year-old girl diagnosed as suffering from dementia praecox who was treated with 15 unmodified ECTs in 3 days. She developed an organic brain syndrome over a period of 3 weeks.

The presence of physical illness does not appear to be a contraindication for ECT in most cases. Mansheim described a patient with meningomyelocele, hydrocephalus with functioning shunt, and seizures who tolerated ECT well. Schneekloth et al. reported on a patient with a kidney transplant who had no harmful effects from ECT. Warren et al. described an individual with major depression and comorbid Down's syndrome who showed no unwanted effects.

Bender reported one case of a fractured vertebra. This occurred before the introduction of modified ECT...Five patients were reported to have ended the course of ECT prematurely because of side effects. These included a depressed teenager who underwent a switch to mania after five ECTs; two whose treatment was discontinued because of increasing agitation; one who showed marked confusion after two treatments; and an 18-year-old female patient with bipolar disorder who developed neuroleptic malignant syndrome following one ECT, after which the course was terminated. She had been given droperidol before and after ECT.

Seizures

Prolonged seizures induced by ECT (lasting more than 180 seconds) and post-ECT seizures have been described. Guttmacher and Cretella reported prolonged convulsions in three cases. Two of these patients were taking concurrent medication (one was taking desipramine and one trifluoperazine). The third adolescent suffered from Tourette's disorder and pervasive developmental disorder and had had a seizure at the age of 11 years. Ghaziuddin et al also reported prolonged seizures in five of seven cases. ... Prolonged seizures were described in another three patients (2%) out of 142 treatments. ...

Bender reported one case of post-ECT seizures in a child who had had a convulsion at the age of 18 months. It is noteworthy that most (72%) of the children she described had abnormal EEGs prior to ECT. The EEG had worsened in only one of the 22 patients tested 6 months later (this was a child with petit mal before ECT), while the EEG improved in eight (36%). Post-ECT seizures were described in another three patients. One of them, a mentally retarded boy, developed a nonconvulsive status epilepticus following the ninth ECT. He was also taking neuroleptics.

Although there is concern that the seizure threshold may be lower in children and adolescents, the evidence that young people are particularly at risk of having lengthy convulsions or of developing post-ECT seizures is not persuasive. The rate of lengthy seizures in the young does not seem to be greater than the rate of 1.1% cited for adults.

Other Adverse Events

Overall, the most common complaint was headache, reported in 16 cases. Subjective memory loss was described in nine patients and manic symptoms in seven. Disinhibition was described in two subjects and hemifacial flushing in one.

The frequency of side effects was higher in recent studies that examined them systematically. ...Kutcher and Robertson reported mild, transient side effects following 28% of ECTs: headache, 15%; confusion, 5%; agitation, 3%; hypomanic symptoms, 2%; subjective memory loss, 2%; and vomiting, 1%. This suggests that minor, transient side effects have often been underreported or overlooked.

Cognitive Functioning

In another study, children were asked to draw human figures and perform the "visual motor gestalt test" before and after ECT. The abnormalities that occurred lasted up to 6 hours after each daily ECT and increased throughout the course, but they cleared approximately 36 hours after the last treatment. ...Another study reported that intellectual "efficiency" was reduced immediately after a course of treatment but recovered at follow-up 5-27 months later. Six individuals in other studies developed an organic brain syndrome that resolved quickly after cessation of treatment.

Overall, adverse events appear similar in type and frequency to those described for adults. ...it is not certain that more serious adverse events did not occur. Also, side effects were often not commented upon and were seldom scrutinized systematically.