A 25-year-old man had a sudden pain followed by involuntary movements in his right arm. A few minutes later, he had a new episode with loss of consciousness. Nine years earlier, he had had a depressed frontal fracture, epidural hematoma, and cerebral contusion that left him with a mild stutter.

On examination, the only finding was a difficulty with oral expression. The initial diagnosis was partial seizures, and treatment with phenytoin and carbamazepine was started. Psychomotor attacks appeared 3 days later. Cerebrospinal fluid was normal. Computed tomography and magnetic resonance imaging showed post-traumatic changes in the right frontal and left temporal lobes. Electroencephalography showed slow activity in the left hemisphere with temporal predominance. Progressively, the patient had mental deterioration and rigidity. He was receiving phenytoin, carbamazepine, and phenobarbital. The rigidity disappeared with the administration of diazepam. However, uncoordinated movements of both eyes and the right arm, autonomic hyperactivity, and the Babinski sign then appeared. The electroencephalogram showed rhythmic theta-delta activity of bilateral distribution with unstable morphology and intensity.

Because the seizures were uncontrolled, a pentobarbital coma was induced. After 40 days of treatment, we tried electroconvulsive therapy. After the second attempt, we were able to remove barbiturates from the patient's treatment regimen. The patient received six electroconvulsive therapy sessions (three per week) and completely recovered within 1 month.

Electroconvulsive therapy has occasionally been used to treat seizures and other neurological disorders [1-3]. Research in animals and humans has shown that this therapy results in an increased seizure threshold that typically increases progressively over a course of treatment. Some authors [1] have suggested that the anticonvulsant effect of electroconvulsive therapy is produced by increased transmission of -aminobutyric acid.

The guidelines on medical treatment of epilepsy are clear [4]. But when no response occurs, electroconvulsive therapy might be a useful adjunct with low morbidity. Nevertheless, its use might be considered an exceptional therapeutic strategy that must be justified on a case-by-case basis.