LAUSR

We report the case of a middle-aged woman with two spinal cord stimulators in situ for treatment of chronic back pain, whose Major Depressive Episode was safely and effectively treated with a course of bifrontal electrode placement, 1.0 ms pulse-width electroconvulsive therapy (ECT). To our knowledge, this is the first report of a patient with implanted spinal cord stimulators who was treated with ECT. Of significance, the ECTwas safe and effective in treating the patient’s depression. Spinal cord stimulation (SCS) is a neuromodulation technique used to treat various forms of treatment-refractory chronic back pain, particularly in failed back surgery syndrome (FBSS). SCS involves percutaneous or surgical implantation of electrodes in the epidural space, which are connected to a battery-powered implantable pulse generator (IPG). The stimulator delivers electrical pulses in pre-determined patterns established by parameters such as pulse-width, frequency and amplitude. Whilst its mechanisms of analgesic action are not well understood [1,2], increasing evidence from clinical trials support its analgesic efficacy in what can be a severely debilitating and distressing condition [1,3]. ECT is an antidepressant intervention which involves the passage of an electrical current through pre-determined electrode configurations placed on the recipient’s scalp to induce a seizure. Whilst a recent case report and literature review reported on the safety of ECT in patients with implanted deep brain stimulators (DBS) [4], there is no literature describing the feasibility, safety or efficacy of ECT applied to patients with implanted SCS. The patient was a 68-year-old married woman with a 40-year history of recurrent Major Depressive Disorder. Relatively high dose psychotropic medication regimens over adequate durations did not result in improvement of her most recent relapse over 18 months. On presentation, the patient reported severely low mood, anhedonia, low energy, poor motivation, diurnal variation with mood worst in the mornings, along with hopeless, helpless