ECT AS A THERAPEUTIC OPTION IN SEVERE BRAIN INJURY

Electroconvulsive therapy (ECT) is a safe, highly effective, and rapid ly acting treatment for certain major psychiatric illnesses, most nota bly severe mood disorders. Disturbances in mood and behavior as sympto ms of delirium may complicate recovery from traumatic brain injury, bu t virtually no data exist on the role of ECT as a treatment modality i n such clinical situations. We describe a patient with severe, unremit ting, agitated behavior following a severe closed head injury from a m otor vehicle accident. The initial Glasgow Coma Scale score was 3, wit h computed tomographic evidence of bilateral frontal and left thalamic contusions. After awakening from a 21-day coma, the patient failed to improve beyond a Ranchos Los Amigos level 4 recovery stage. He exhibi ted persistent severe agitation with vocal outbursts and failed to ass ist in performing activities of daily living. His difficulties proved unresponsive to combined behavioral therapy and multiple trials of var ious psychopharmacologic agents. As an intervention of ''last resort,' ' he then received six brief-pulse, bilateral ECT treatments that resu lted in marked lessening of his agitation and improvement in his abili ty to express his needs and participate in his self-care. Also, follow ing the ECT, he showed a markedly enhanced response to psychopharmacol ogic agents. These findings may have important clinical implications f or treatment of prolonged delirium after traumatic brain injury.