Little is known about the use of electroconvulsive therapy (ECT) in patients with intracranial metallic objects. Theoretically, electric current might cause heating of the metal and damage of the surrounding brain tissue. Moreover, intracranial foreign objects increase the risk for epileptic phenomena and could thus complicate the treatment course.
The case of a man with intracranial bullet fragments as a result of a headshot, treated with ECT for mania, is presented. We conducted a PubMed literature search for other relevant cases.
In our patient, ECT was completed without complication. Electroconvulsive therapy was safely administered in 22 published cases of patients with intracranial metallic objects.
After carefully weighing benefits and risks in each individual case, psychiatrists should not be reluctant to use ECT in patients with intracranial metallic objects. Apart from avoiding empirical dosage titration to minimize the exposure to current, positioning the electrodes to avoid the electric current of heating the metal, and continuing antiepileptic agents in high-risk patients, no precautions need to be considered.