Successful Electroconvulsive Therapy for a Patient With McArdle Disease
Electroconvulsive therapy (ECT) is a recommended option for patients with treatment-resistant depression and a high risk of suicide and for other severe mental illnesses. The efficacy of ECT is dependent on the duration of the electrically induced seizure delivered in anesthetized patients. Increased muscular activity during a seizure may produce rhabdomyolysis, especially in patients with hereditary metabolic disorders such as McArdle disease.
McArdle disease, also known as glycogen storage disease type V (GSD-V), is the most common metabolic myopathy of muscle carbohydrate metabolism, caused by mutations in the PYGM gene on chromosome 11q13, which encodes the muscle glycogen phosphorylase.1 Patients with GSD-V typically present exercise intolerance, episodic rhabdomyolysis, and the second wind phenomenon. The lack of the glycolytic enzyme is responsible for an inability to use glycogen reserves and is suspected for increasing the risk of hyperkalemia, myoglobinuria, and acute renal failure. Psychiatrists may hesitate to perform ECT on patients with such somatic risks.
Here, we first demonstrate the safety and the efficacy of ECT in a patient with GSD-V, using anesthesia with rocuronium-sugammadex.