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Successful Electroconvulsive Therapy in Idiopathic Intracranial Hypertension With Mood Disorder and Partial Empty Sella Syndrome

Patients with idiopathic intracranial hypertension (IIH) often experience significant burden from psychiatric comorbidities. Mood disorders are present in up to half of all patients with IIH, and they are often refractory to treatment by psychopharmacologic agents. Electroconvulsive therapy (ECT) is...

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Autores principales: Parker, Maxwell T., Putinta, Kevin M., Carr, Brent R.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Lippincott Williams & Wilkins 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10487363/
https://www.ncbi.nlm.nih.gov/pubmed/36215412
http://dx.doi.org/10.1097/YCT.0000000000000889
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author Parker, Maxwell T.
Putinta, Kevin M.
Carr, Brent R.
author_facet Parker, Maxwell T.
Putinta, Kevin M.
Carr, Brent R.
author_sort Parker, Maxwell T.
collection PubMed
description Patients with idiopathic intracranial hypertension (IIH) often experience significant burden from psychiatric comorbidities. Mood disorders are present in up to half of all patients with IIH, and they are often refractory to treatment by psychopharmacologic agents. Electroconvulsive therapy (ECT) is the criterion standard for treatment of patients with the most severe psychiatric burden but has relative contraindications in those possessing pathologies that raise intracranial pressure (ICP). There is a growing body of literature that a multidisciplinary care model would allow for patients with elevated ICP to receive ECT safely. Despite the high prevalence of mood disorders in patients with IIH, there are only 2 published case reports describing ECT delivery to patients from this cohort. We report our own case of a patient with IIH and major depressive disorder who received 38 bitemporal treatments with a positive response and no change in baseline ICP. Her positive response, along with the absence of elevation of ICP, aligns with the prior reports; however, her IIH symptoms have not responded as reported in the 2 cases—despite receiving more than 4 times the amount of treatments. Moreover, our patient possessed unique imaging for a partial empty sella syndrome, which has recently been found to be the only significant finding in patients who had a mood disorder before IIH diagnosis, versus a mood disorder developing after IIH diagnosis. This case serves to provide evidence of the safety and success of ECT in patients with IIH, relying on multidisciplinary care from psychiatry, neurology, and neuro-ophthalmology.
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spelling pubmed-104873632023-09-09 Successful Electroconvulsive Therapy in Idiopathic Intracranial Hypertension With Mood Disorder and Partial Empty Sella Syndrome Parker, Maxwell T. Putinta, Kevin M. Carr, Brent R. J ECT Case Report Patients with idiopathic intracranial hypertension (IIH) often experience significant burden from psychiatric comorbidities. Mood disorders are present in up to half of all patients with IIH, and they are often refractory to treatment by psychopharmacologic agents. Electroconvulsive therapy (ECT) is the criterion standard for treatment of patients with the most severe psychiatric burden but has relative contraindications in those possessing pathologies that raise intracranial pressure (ICP). There is a growing body of literature that a multidisciplinary care model would allow for patients with elevated ICP to receive ECT safely. Despite the high prevalence of mood disorders in patients with IIH, there are only 2 published case reports describing ECT delivery to patients from this cohort. We report our own case of a patient with IIH and major depressive disorder who received 38 bitemporal treatments with a positive response and no change in baseline ICP. Her positive response, along with the absence of elevation of ICP, aligns with the prior reports; however, her IIH symptoms have not responded as reported in the 2 cases—despite receiving more than 4 times the amount of treatments. Moreover, our patient possessed unique imaging for a partial empty sella syndrome, which has recently been found to be the only significant finding in patients who had a mood disorder before IIH diagnosis, versus a mood disorder developing after IIH diagnosis. This case serves to provide evidence of the safety and success of ECT in patients with IIH, relying on multidisciplinary care from psychiatry, neurology, and neuro-ophthalmology. Lippincott Williams & Wilkins 2023-09 2022-10-01 /pmc/articles/PMC10487363/ /pubmed/36215412 http://dx.doi.org/10.1097/YCT.0000000000000889 Text en Copyright © 2022 The Author(s). Published by Wolters Kluwer Health, Inc. https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND) (https://creativecommons.org/licenses/by-nc-nd/4.0/) , where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.
spellingShingle Case Report
Parker, Maxwell T.
Putinta, Kevin M.
Carr, Brent R.
Successful Electroconvulsive Therapy in Idiopathic Intracranial Hypertension With Mood Disorder and Partial Empty Sella Syndrome
title Successful Electroconvulsive Therapy in Idiopathic Intracranial Hypertension With Mood Disorder and Partial Empty Sella Syndrome
title_full Successful Electroconvulsive Therapy in Idiopathic Intracranial Hypertension With Mood Disorder and Partial Empty Sella Syndrome
title_fullStr Successful Electroconvulsive Therapy in Idiopathic Intracranial Hypertension With Mood Disorder and Partial Empty Sella Syndrome
title_full_unstemmed Successful Electroconvulsive Therapy in Idiopathic Intracranial Hypertension With Mood Disorder and Partial Empty Sella Syndrome
title_short Successful Electroconvulsive Therapy in Idiopathic Intracranial Hypertension With Mood Disorder and Partial Empty Sella Syndrome
title_sort successful electroconvulsive therapy in idiopathic intracranial hypertension with mood disorder and partial empty sella syndrome
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10487363/
https://www.ncbi.nlm.nih.gov/pubmed/36215412
http://dx.doi.org/10.1097/YCT.0000000000000889
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