ELECTROCONVULSIVE-THERAPY IN PATIENTS TAKING THEOPHYLLINE

Background: Initiating a course of electroconvulsive therapy (ECT) in patients taking theophylline has been associated with status epileptic us and consequent brain damage or even death. However, some patients w ith severe pulmonary conditions may both require theophylline and be s eriously depressed enough to warrant ECT. Deciding whether to use ECT in such patients is a fairly common clinical problem. Method: The reco rds of seven patients taking theophylline during nine courses of ECT w ere reviewed to ascertain whether inordinately long seizures occurred. Results: In 77 documented seizures, there was one 190-second seizure a s measured by EEG. All others were shorter than 100 seconds, and mean motor and EEG seizure lengths were comparable with those reported in t he literature. Conclusion: Theophylline coadministration is a risk fac tor for prolonged seizures in patients starting a course of ECT. Howev er, in most severely depressed, medication-refractory patients, a cour se of ECT can be undertaken with safety. Precautions that can decrease the risk of prolonged seizures are discussed.