Safety of repeated courses of electroconvulsive therapy in a patient with Harrington rods

Background: Although modified electroconvulsive therapy (ECT) may rarely result in musculoskeletal complications, it has also been safely administered to patients with orthopedic morbidity. There is no literature on the safety of repeated courses of ECT in patients with Harrington rod implants. Case Report: We describe a 30-year-old asthenic bipolar woman who, in 1997, had a Harrington compression assembly stabilizer fitted for spinal tuberculosis and who, between 2000 and 2004, received 3 courses of modified ECT with a total of 28 treatments. In October 2006, she experienced her index episode of mania and was treated with 7 ECTs that were modified with propofol (60 mg) and succinylcholine (0.83 mg/kg). Each ECT seizure was characterized by mild tonic-clonic movements that lasted 20 to 40 seconds. Her mania remitted uneventfully with ECT. Radiological assessment after the ECT course showed that there were no orthopedic complications. Discussion: Although our patient experienced no musculoskeletal complication despite the incomplete muscle relaxation, for maximum safety, we strongly recommend full muscle relaxation for all patients with orthopedic conditions who are treated with ECT. We also suggest that in such patients, short stimulus durations be used (to the extent possible) to minimize the duration of the tonic muscular contraction that occurs during the passage of the ECT stimulus. With these precautions, the orthopedic risks associated with well-modified ECT may be no greater or less than those associated with a fit of sneezing or coughing. Our report adds to the literature on the safety of modified ECT in patients with orthopedic conditions, such as those with Harrington rods in situ.