Procedural Consolidation During Electroconvulsive Therapy for a Patient With Severe Tourette Syndrome.

with stimulus energies set to 100%. Anesthetic agents used for the ECT procedures included methohexital 90 mg intravenous and succinylcoline 100 mg intravenous. The patient experienced 3 ECT episodes that lacked appropriate EEG seizure duration documentation despite blood pressure and heart rate changes typically associated with seizure activity. During each of these episodes, the patient was being treated with diltiazem extended-release 180 mg daily. Upon discontinuation of diltiazem and concurrent switch to bitemporal stimulus electrode placement, the treatment-induced seizures began to reach more predictable durations. Diltiazem seemed to interfere with achieving full ECT treatment seizures. Wajima et al compared 18 patients taking diltiazem 10 mg intravenous daily or placebo and reported a significantly shorter EEG seizure duration in the diltiazem group (P < 0.05). These patients also exhibited predictable increases in hemodynamics, which was precisely what was observed in this reported patient case. Verapamil, another nondihydropyridine calcium channel blocker, was compared with placebo in patients undergoing ECT and found no reduction of seizure duration, so this phenomenon is not necessarily class specific.