Durable response to electroconvulsive therapy with atypical electrode placement in a post-middle cerebral artery stroke patient

Electroconvulsive Therapy (ECT) is a highly efficacious treatment for severe and often refractory affective and psychotic illnesses. Case reports also describe effective and durable responses in patients with neurologic disorders complicated by psychiatric syndromes. Recommendations on ECT technique include avoiding electrical stimulation over areas of known skull or brain abnormalities. We present a patient with a perinatal, large right middle cerebral artery (MCA) infarct affecting the entirety of the MCA distribution who safely underwent a full series of ECT using an alternative placement. ECT was well tolerated with rapid resolution of symptoms. With subsequent maintenance ECT, response was durable at eighteen months.