Aminophylline as an adjunct to enhance seizure adequacy in electroconvulsive therapy: a three-case series

This is the authors' abstract. We don't add key points for this paper.

Background Electroconvulsive therapy (ECT) remains one of the most effective treatments for severe psychiatric disorders. Achieving an adequate therapeutic seizure, particularly when maximal electrical stimulation is reached, remains challenging. Xanthine derivatives such as aminophylline may enhance seizure adequacy through adenosine receptor antagonism, thereby increasing neuronal excitability. Case presentations This paper reports three patients differing in terms of age, gender, and mental disorder indication, who exhibited suboptimal seizure activity despite maximal ECT stimulation on the MECTA SpECTrum machine (576 mC) for whom intravenous aminophylline (3–5 mg/kg) was administered 10 minutes prior to ECT to explore tolerability and efficacy in improving seizure outcomes. IV aminophylline was associated with restoration of adequate seizure duration and clinical improvement in all cases. One patient developed transient hypertension managed with nitroglycerin; no other significant adverse effects were observed. Aminophylline was well tolerated and was associated with prolonged seizure duration and improved therapeutic outcomes. Conclusions These findings suggest that aminophylline may serve as a well-tolerated, cost-effective, and accessible proconvulsant augmentation strategy in ECT, particularly in resource-limited settings, warranting further controlled studies to confirm efficacy and safety.