Betty Shafran Suffered serious injuries following electroconvulsive therapy (ECT)
In July, 1990, Mrs. Shafran voluntarily sought treatment for depression at St. Vincent’s Hospital, New York. Her prescribed antidepressant treatment didn’t seem to help so ECT was considered since Shafran had some benefit from electroshock decades prior.
Risks weighed
About a month prior to being hospitalized for depression Mrs. Shafran was treated for respiratory problems following pneumonia:
“Shafran was admitted to St. Vincent’s Hospital by her internist, defendant Margaret Burns, M.D., after Shafran complained of respiratory problems. Shafran had pneumonia and was in respiratory distress. She was intubated and received a full pulmonary consultation by a pulmonologist. Shafran was also continued on the drug theophylline, a bronchodilator commonly used to treat lung diseases. Upon her release, she was diagnosed with chronic obstructive pulmonary disorder.”
Bluebook, Shafran v. St. Vincent’s Hospital and Medical Center, 264 A.D.2d 553, 694 N.Y.S.2d 642 (App. Div. 1999).
Drug risks were considered; theophylline, the bronchodilator Shafran was prescribed for respiratory distress, could cause prolonged seizures (status epilepticus) if drug levels were too high when undergoing ECT.
Her theophylline dosage was reduced but blood levels weren’t tested before ECT:
Although Shafran’s blood level was not taken again prior to the September 7th ECT procedure, Dr. Burns and Dr. Nathanson testified that the 25% reduction in theophylline would result in reduction of the blood-level of the medication to within the therapeutic range…
Bluebook, Shafran v. St. Vincent’s Hospital and Medical Center, 264 A.D.2d 553, 694 N.Y.S.2d 642 (App. Div. 1999).
Prolonged Seizure,Coma and Disabling InjurIes
On September 7th, Mrs. Sharfran underwent ECT. Following the induced seizure a second prolonged seizure began lasting several hours. It was followed by a 10 day coma.
Her lasting injuries following status epilepticus and coma included a seizure disorder, severe memory loss, and bitemporal deafness.
Mrs. Shafran died six years later.
Her husband, Jack Shafran, sued the hospital and involved parties for malpractice but was unsuccessful. View case details.
Electrical exposure
Several aspects of Mrs. Shafran’s case caught my attention after experiencing electrical injury consequences firsthand:
- Theophylline is a bronchodilator.
- Bronchodilators cause potassium levels to drop.
- Electrical injury can cause ion channel dysfunction called acquired channelopathies.
- Mrs. Shafran was given ECT in the 1960s. This electrical exposure may have led to the development of channelopathies, depending on how her body responded to electrical exposure, medications in her system during treatment, and the other variables associated with injury from ECT, outlined by electroshock device manufacturer’s Somatics, LLC, regulatory update:
Cognitive side effects are experienced in varying types and severity by ECT patients. Studies have shown that the methods used in ECT administration have a significant impact on the nature and magnitude of cognitive deficits. In general, the American Psychiatric Association recognizes that the following treatment parameters are each independently associated with more intense cognitive side effects:
• Bilateral electrode placement;
• Sine wave stimulation;
• High electrical dosage relative to seizure threshold;
• Closely spaced treatments;
• Larger numbers of treatments;
• Concomitant psychotropic medications;
• High dosage of barbiturate anesthetic agents.
ECT may result in anterograde or retrograde amnesia. Such post-treatment amnesia typically dissipates over time; however, incomplete recovery is possible. In rare cases, patients may experience permanent memory loss or permanent brain damage.
Other serious adverse events have occurred, including adverse reaction to anesthetic agents neuromuscular blocking agents; adverse skin reactions (e.g., skin burns); cardiac complications, including arrhythmia, ischemia/infarction (i.e., heart attack), acute hypertension, hypotension, and stroke; cognition and memory impairment; brain damage; dental/oral trauma; general motor dysfunction; physical trauma (i.e., if inadequate supportive drug treatment is provided to mitigate unconscious violent movements during convulsions); hypomanic or manic symptoms (e.g., treatment emergent mania, postictal delirium or excitement); neurological symptoms (e.g., paresthesia, dyskinesias); tardive seizures; prolonged seizures; non-convulsive status epilepticus; pulmonary complications (e.g., aspiration/inhalation of foreign material, pneumonia, hypoxia, respiratory obstruction such as laryngospasm, pulmonary embolism, prolonged apnea); visual disturbance; auditory complications; onset/exacerbation of psychiatric symptoms; partial relief of depressive anergia enabling suicidal behavior; homicidality; substance abuse; coma; falls; and device malfunction (creating potential risks such as excessive dose administration).”
Somatics Regulatory Update, ECT Device Manufacturer Admits Brain Damage as a Risk of Electroconvulsive Therapy
Electrical Injury can profoundly alter human physiology down to the ionic level
ECT recipients report serious physiological symptoms related to acute potassium drops. Doctors unfamiliar with cardiac and neuromuscular channelopathies assume symptoms caused by electrolyte dysregulation are psychosomatic in nature.
Mrs. Shafran had ECT in the 1960s which leads me to wonder if there’s a link between prior electrical exposure and her emotional decline following the use of a bronchodilator prescribed for her respiratory distress years later.
We can only speculate on her case. What we do know is electrical injury has many immediate and long term consequences that are not well known or understood.
Dangers of undiagnosed electrical injury
In addition to dangerous reactions to bronchodilators former ECT recipients report life threatening reactions to other common drugs that act on potassium, calcium and sodium ion channels. These include over-the-counter allergy medications like Benadryl and Allegra and local anesthetics such as lidocaine.
Our doctors never would have linked these reactions to ECT. Our lives were endangered by their lack of knowledge. In some cases our symptoms were dismissed as psychiactric instead of physiological and we were denied proper medical intervention.
There are so many things we can’t know about Mrs. Shafran’s experience, but we do know the same ignorance of the effects of ECT that led to her injuries still exist today, exposing present day ECT recipients to immediate and long-term risks.
Doctors are dangerously unaware of the consequences of electrical injury
- Psychiatrists providing ECT aren’t required to understand pathophysiology of repeated exposure to high (bipolar-pulsed) electric fields nor do they have training in Physics to distinguish between ECT settings (pulsed electric fields).
- ECT has never been proven safe by required FDA testing, and is not standardized or regulated.
- If doctors don’t know about these risks, how will their patients? Practitioners outside psychiatry lack vital information regarding ECT’s consequences, further endangering patients long after their last shock treatment.
- Doctors certainly aren’t reporting them; a look at the Manufacturer and User Facility Device Experience (MAUDE) database, shows little if any submissions from medical professionals. How can one know how rare adverse events are if no one on the frontlines is reporting them? We know deaths go unreported, its likely more so with non-fatal adverse events like I’ve described (see ECT related death not properly addressed due to COVID-19 and Patients Often Aren’t Informed of Danger of ECT).
- The politicized nature of ECT may makes many doctors hesitant or unwilling to consider obscure side effects reports they hear, leaving their patients at risk of serious complications.
- Injured ECT recipients are on their own; no one who has it is given comprehensive assessments for known adverse events like those experienced by Mrs. Shafran. Without support from healthcare providers, those harmed will have to decipher complex medical symptoms independently if they are to survive life after ECT.
We can only imagine what the last six years of life were like for her and husband without proper testing and treatment for her debilitating injuries.
Learn how you can help change this: sign this patient safety petition.
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Links
- Shafran v. St. Vincent’s Hospital and Medical Center, 264 AD 2d 553 – NY: Appellate Div., 1st Dept. 1999 – Google Scholar
- Low blood potassium: MedlinePlus Medical Encyclopedia
- Theophylline: Uses, Interactions, Mechanism of Action | DrugBank Online
- Status Epilepticus as a Complication of Concurrent Electroconvulsive and Theophylline Therapy – Mayo Clinic Proceedings
- Acquired Channelopathies Secondary to Repetitive Low Voltage Electrical Injury
- Frontiers | Major channels involved in neuropsychiatric disorders and therapeutic perspectives | Genetics (frontiersin.org)
- Understanding Electrical Injury – Dr. Marc Jeschke
- ECT Device Manufacturer Admits Brain Damage as a Risk of Electroconvulsive Therapy
- Aging after ECT, episodic paroxsomal neuromuscular symptoms and blood brain barrier
- ECT as Repetitive Electrical Trauma, ALS & Increased Veterans’ Suicide
- Microstructural Damages Caused by Electroconvulsive Therapy (ECT)
- Cortical auditory disorders: clinical and psychoacoustic features
- Fexofenadine – StatPearls – NCBI Bookshelf (nih.gov)
- Diphenhydramine Toxicity – StatPearls – NCBI Bookshelf (nih.gov)
- Lidocaine Toxicity – StatPearls – NCBI Bookshelf (nih.gov)
- Types of Ion Channels in the Body (news-medical.net)
- Ligand Gated Ion Channels | Nervous system physiology | NCLEX-RN | Khan Academy
- Gender Bias in Clinical Trials (appliedclinicaltrialsonline.com) (women process medications differently than men but are left out of drug trials meaning they take men’s dosing. Another risk women who receive ECT face is lack of drug testing on female subjects in drug trials. Gender is more than body parts — it shapes all aspects of physiology. Women may be at greater risk with medications prescribed before, during, and after ECT as they have only been tested on men. In the case of Shafran, she may have needed a greater reduction of theophylline than was recommended based on gender bias in drug research).
