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Electroconvulsive Therapy in Elderly Patients With Cerebral Aneurysms: A Systematic Review With Clinical Recommendations
Journal of Geriatric Psychiatry and Neurology ( IF 2.6 ) Pub Date : 2021-08-17 , DOI: 10.1177/08919887211039016
Syed Muhammad Ahsan Mehdi 1 , D P Devanand 2
Affiliation  

Introduction:

Electroconvulsive therapy (ECT) is commonly used in the elderly due to its proven efficacy and safety profile. However, presence of cardiovascular comorbidities such as cerebral aneurysms may complicate the course of treatment. Our knowledge about the possible risk factors and precautionary measures remains limited.

Methods:

We performed a systematic review of published case reports of elderly patients with cerebral aneurysms treated with ECT.

Results:

A total of 11 cases were included for the review. One patient died because of subarachnoid hemorrhage (SAH) secondary to ictal hypertensive surge during treatment with ECT.

Discussion:

Risk factors such as history of hypertension, age of the patient, extent of the ictal surge in blood pressure, efficacy of prophylactic treatment to control surge in blood pressure and characteristics of cerebral aneurysm each elevated the risk of complication in these cases. We reviewed safety measures based on the evidence from the current literature available.

Conclusion:

ECT is safe in elderly patients with cerebral aneurysms provided appropriate safety measures are employed. Screening for cerebral aneurysms in high risk patients, effective prevention and management of blood pressure elevation acutely during ECT is the best practice to avoid adverse outcomes.



中文翻译:

老年脑动脉瘤患者的电休克治疗:具有临床建议的系统评价

介绍:

电休克疗法 (ECT) 因其经证实的有效性和安全性而常用于老年人。然而,心血管合并症如脑动脉瘤的存在可能会使治疗过程复杂化。我们对可能的风险因素和预防措施的了解仍然有限。

方法:

我们对已发表的接受 ECT 治疗的老年脑动脉瘤患者的病例报告进行了系统评价。

结果:

共纳入 11 例进行审查。一名患者因 ECT 治疗期间继发于发作期高血压激增的蛛网膜下腔出血 (SAH) 而死亡。

讨论:

高血压病史、患者年龄、发作期血压升高的程度、控制血压升高的预防性治疗的有效性和脑动脉瘤的特征等危险因素均增加了这些病例的并发症风险。我们根据现有文献中的证据审查了安全措施。

结论:

如果采取适当的安全措施,ECT 在老年脑动脉瘤患者中是安全的。筛查高危患者的脑动脉瘤,有效预防和管理 ECT 期间急性血压升高是避免不良后果的最佳做法。

更新日期:2021-08-17
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