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The following is a summary of “Raised Intracranial Pressure in Seizures Induced by Electroconvulsive Therapy,” published in the April 2025 issue of European Journal of Neurology by Spoor et al. 

Increased intracranial pressure (ICP) occurs during seizures but is rarely factored into epilepsy-related complications.  The optic nerve sheath diameter (ONSD) provides a non-invasive method for tracking these changes during electroconvulsive therapy (ECT). 

Researchers conducted a retrospective study to assess ICP changes using optic nerve sheath diameter in patients undergoing electroconvulsive therapy. 

They measured ONSD in 27 ECT-induced seizures from 9 consecutive patients at baseline (t0), during injection of suxamethonium (sux) (t1), after injection of sux (t2), during the electrically induced seizure (t3), and after the seizure (t4). A linear mixed model was applied to analyze the data and assess the changes in ONSD at different time points. 

The results showed an increase in ONSD of >0.2 mm from t0 to t3 in all patients except one. ONSD significantly increased during succinylcholine-induced fasciculations (t₁, β = 0.535 mm, P < 0.001) and during the electrically induced seizure (t₃, β = 1.02 mm, P < 0.001). ONSD returned to baseline after the fasciculations (t₂, β = 0.091 mm, P = 0.443) and after the seizure (t₄, β = 0.103 mm, P = 0.379). 

Investigators found that generalized convulsive seizures caused a transient but pronounced increase in ONSD, indicating a temporary rise in ICP. 

Source: onlinelibrary.wiley.com/doi/full/10.1111/ene.70149