Electroconvulsive Therapy in a Patient with Polymethyl Methacrylate Cranioplasty: A Case Report

Aim and background: Traumatic brain injury (TBI) can lead to various psychiatric complications, including depression, mania, anxiety disorders, psychotic syndromes, and cognitive and behavioral impairments.Electroconvulsive therapy (ECT) is one of the most effective treatments for several psychiatric disorders.However, there is limited literature on the safety and efficacy of ECT in patients who have undergone craniectomy with polymethyl methacrylate (PMMA) cranioplasty following head injury.Case description: We present the case of an adult diagnosed with schizoaffective disorder and TBI sequelae with a history of right craniectomy and PMMA cranioplasty.The patient underwent a total of six sessions of left unilateral ECT after a thorough evaluation by a multidisciplinary team, including a psychiatrist, general physician, neurosurgeon, and anesthetist.At baseline, the Brief Psychiatric Rating Scale (BPRS) score was 61, which reduced to 24 post-ECT, indicating complete remission.Cognitive assessment was conducted using the electroconvulsive therapy cognitive assessment (ECCA) scale, with scores of 23 at baseline, 21 at mid-treatment (after the third ECT session), and 24 posttreatment (after the sixth ECT session).Conclusion: This case highlights that, with careful evaluation, ECT can be safely administered in patients with PMMA cranioplasty implants without adverse effects.Special attention should be given to electrode placement to avoid skull defects.Clinical significance: This case adds to the limited body of evidence supporting the safe use of ECT in patients with PMMA cranioplasty following TBI.With appropriate precautions, including careful electrode placement and cognitive monitoring, ECT remains a viable and effective treatment option in patients with PMMA cranioplasty.