Musculoskeletal Morbidity with Unmodified Ect May Be Less than Earlier Believed

Official guidelines for the practice of electroconvulsive therapy (ECT) recommend routine seizure modification to minimize musculoskeletal complications; nevertheless, unmodified ECT continues to be administered in India. We therefore assessed musculoskeletal morbidity with unmodified ECT with particular reference to the development of vertebral fractures and backache X-rays of the thoracolumbar spine were routinely obtained before and after a course of 6 ECTs in 50 consecutive schizophrenic patients receiving unmodified sinusoidal wave treatment.Backache was reported by 52% of patients; the symptom was severe in 14%. Severe backache developed early during the ECT course and was commoner in older patients. Gender, height and weight did not predict either presence or severity of backache. One patient experienced a vertebral fracture which was not considered serious this contrasts with the 20-40% incidence of adverse orthopedic events described with unmodified ECT in early studies. There were no other untoward events. It is concluded that, with specific reference to Indian patients, musculoskeletal morbidity with unmodified ECT may be less than earlier believed Risks with modified vs unmodified ECT therefore need to be systematically reassessed, and decision-making processes may need to be reformulated taking individual situations into account. The findings, conclusions and recommendations of this study carry much medicolegal significance for practitioners of ECT in India.