Postictal neurogenic pulmonary edema: Experience from an ECT model

Neurogenic pulmonary edema (NPE) is thought to rarely occur after seizures. Paradoxically, NPE is frequently found (>80%) at autopsy in epileptic patients who die unexpectedly. The reason for the discrepancy between the frequency of NPE found at autopsy and that after uncomplicated seizures is unclear. The literature suggests that subclinical NPE occurs rarely after uncomplicated seizures and resolves within a few hours, but is undetected because of infrequent use of routine chest radiographs early after a seizure occurs. This pilot study examined the frequency of subclinical, radiographically confirmed NPE after electroconvulsive therapy (ECT)-induced seizures. If shown to occur, ECT-induced subclinical NPE would provide an easily reproducible model to study NPE after seizures in patients with epilepsy. Given that sudden unexplained death syndrome accounts for ~10% of the deaths in patients with epilepsy, an easily reproducible model for NPE would have heuristic value. We examined 12 patients undergoing ECT for depression with chest radiographs before and after ECT. In this group, only 1 of the 12 patients had subclinical NPE in their post-ECT radiograph. We conclude that subclinical NPE does not significantly occur after seizures in patients undergoing ECT and therefore, would not serve as an application for research.