IS ECT SAFE IN PATIENTS WITH CEREBROVASCULAR-DISEASE

A 70-year-old man with a history of peripheral vascular disease was tr eated initially with antidepressants, then bilateral electroconvulsive therapy (ECT) for a depressive illness. Apart from an episode of deli rium following ECT he recovered fully. Four years later be relapsed. L ow-dose antidepressants caused disorientation and oversedation, as did ECT. Shortly afterwards he developed a multi-infarct state with Parki nsonian symptoms, transient ischaemic attacks (TIAs) and cerebrovascul ar attacks (CVAs). His cognitive deficits implicated pathology in the frontal and subcortical areas of the brain. Postmortem examination con firmed widespread atherosclerotic disease, also cerebrovascular diseas e. The haemodynamic and cerebral effects of ECT are considered in the context of vascular disease. It is postulated that ECT given to such p atients might cause permanent impairment of cognitive function through ischaemia of an already compromised cerebral circulation. Suggestions are outlined regarding a policy for a more comprehensive assessment o f patients with atherosclerotic disease. Deficiencies of ECT procedure s are highlighted.