Is Routine Brain Imagiing Necessary Before Electroconvulsive Therapy?

INTRODUCTION: Electroconvulsive Therapy (ECT) is a treatment method that creates controlled seizures by applying electrical current stimulation to the brain. Although the presence of an intracranial mass is not an absolute contraindication for ECT, it may pose risks that are associated with ECT. The aim of this study is to determine the prevalence of incidental abnormalities that may preclude the use of ECT through routine cross-sectional brain imaging.
METHODS: The medical records of all patients who underwent ECT between January 2010 and June 2021 were reviewed retrospectively. We examined the results of their routine neurological evaluations and any brain imaging reports. In addition, the patient’s sociodemographic characteristics, such as age and gender, and any reports of unexpected complications that arose from the ECT were examined.
RESULTS: A total number of 156 patients who underwent ECT between the dates were examined, of which 113 patients had brain imaging (CT: 58, MRI: 51, Diffusion MRI: 4) performed prior to ECT. The rate of normal findings was 47% in MRI, 86% in CT, and 100% in diffusion MRI. There was no findings that prevented ECT from being performed, and no report that showed increased intracranial pressure, and none of the patients developed an unexpected intracranial complication from ECT.
DISCUSSION AND CONCLUSION: Our results show that routine neuroimaging before ECT is not required. In the clinical examination, we recommend brain imaging before ECT only if there is a suspicion of intracranial pathology and examination findings that indicate this.