Prolonged confusional state and EEG seizure activity following concurrent ECT and lithium use

Abstract

In the recent APA survey on ebectroconvulsive therapy (ECT), only 20% of the psychiatrist respondents felt that lithium carbonate and ECT were incompatible (1). At the same time, however, there is growing evidence (2-6) that this combination may be associated with the development of a severe acute organic brain syndrome, even in patients who tolerate either treatment well when it is given separately. Although only Ray (3) and Small and associates (6) have reported the occurrence of seizure activity as a part of such a syndrome (3, 6), the common presentation of waxing and waning disorientation and confusion is similar to certam types of seizure manifestations. Therefore, we present here a case in which the patient’s EEG showed evidence of status epilepticus while at the same time the patient was in a fluctuating confusional state. Case Report