ECT for a patient with a metallic skull plate

Electroconvulsive Therapy (ECT) is a safe and effective treatment for a variety of psychiatric conditions. The American Psychiatric Association Task Force Report identifies no absolute contraindications to ECT; however, it lists several relative contraindications. The presence of a metallic skull plate is not addressed, nor has it been previously documented in the literature. As a result, there may be reluctance among some psychiatrists to perform ECT under such circumstances. This article reviews the literature for ECT done in the presence of skull defects and intracranial metallic bodies. A case report of ECT being performed on an elderly patient with a metallic skull plate is presented. In the presence of a skull defect, it is advisable to place electrodes equidistant from the defect to reduce the risk of damage. The case report presented adds to the literature to show that ECT may safely be performed in the presence of a metallic skull plate.