Neuropathologic examination after 91 ECT treatments in a 92-year-old woman with late-onset depression

Whereas pathological seizure states, such as temporal lobe epilepsy, are commonly associated with cell loss and glial scarring in the hippocampus, seizures induced via electroconvulsive therapy (ECT) have not been associated with histological evidence of neuronal damage. We present a case report including the late-life medical history and postmortem histology of an elderly woman with major depression who received 91 sessions of ECT during the last 22 years of her life. Given the large number of ECT sessions, and her advanced age, this case provides a strong test of whether ECT causes detectable evidence of neuronal damage. We examined the gross morphology of the hippocampus, hippocampal cytoarchitecture, and measures of neuropathology. We found no pathological changes that could be attributed to ECT. Only expected, age-related features were present. Corpora amylacea and rare neurofibrillary tangles were evident, but we failed to detect any obvious evidence of cell loss or gliosis. Cognition in this patient was intact as indicated by a perfect score on a Mini-Mental Status Examination administered 6 days before death at the age of 92. This case adds to the considerable evidence for the safety of ECT.