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A Case of Atypical Tardive Seizure Activity During an Initial ECT Titration Series

Thisayakorn, Paul MD*; Karim, Yasser MD; Yamada, Thoru MD; McCormick, Laurie M. MD*

doi: 10.1097/YCT.0b013e31829c10d6
Case Reports

Electroconvulsive therapy (ECT) has been used in this country for more than 70 years, is still the most effective treatment in all of psychiatry, and is considered a very safe procedure to have under general anesthesia. Although most patients tolerate this procedure very well without complications, prolonged and/or tardive seizures or even status epilepticus can develop, which is a rare but serious complication of ECT. Tardive seizures are typically associated with electroencephalographic evidence of ictal activity and motor manifestations of the tonic-clonic activity. Whereas there are instances of nonconvulsive status epilepticus after ECT, this is the first report of a patient developing autonomic and motor manifestations of a tardive seizure without electroencephalographic evidence of seizure activity during the initial titration series to establish seizure threshold for a course of ECT.

From the Departments of *Psychiatry, †Anesthesiology and ‡ Neurology, University of Iowa, Carver College of Medicine, Iowa City, IA.

Received for publication April 6, 2013; accepted May 14, 2013.

Reprints: Laurie M. McCormick, MD, University of Iowa, Carver College of Medicine, Department of Psychiatry, Psychiatric Iowa Neuroimaging Center, 200 Hawkins Dr, W278 GH, Iowa City, IA 52242 (e-mail:

The authors have no conflicts of interest or financial disclosures to report.

© 2014 by Lippincott Williams & Wilkins