Patients who develop epilepsy during extended treatment with electroconvulsive therapy

Epidemiologic data indicate that electroconvulsive therapy (ECT) does not precipitate epilepsy. However, when an ECT patient develops this condition, one is faced with the question as to whether ECT caused it and whether ECT can be safely continued. We describe four patients, two of whom developed definite epilepsy and two possible epilepsy during extended courses of ECT. In one of the patients ECT was stopped at that point, but in the other three, ECT was continued without complications or apparent precipitation of spontaneous seizures. We describe some of the clinical challenges in this scenario and provide recommendations regarding continued use of ECT in the newly diagnosed epileptic patient.