Is it necessary to dismiss the ventriculo-peritoneal bypass valve malfunction before undergoing electroconvulsive therapy in patients with normal pressure hydrocephalus (NPH) neurologically asymptomatic?

Introduction: The use of ECT in patients with an intracerebral foreign body arises questions about possible singularities. According to clinical guidelines' recommendations, there is no formal contraindication for the use of ECT in patients with comorbid NPH, not even for those with a valve in place (APA 2001, CANMAT 2016, Spanish ECT Consensus 2018). However, the existence of mechanical complications of the valve, such as an obstruction, might interfere with ECT procedure. Objectives: To review the described pre-ECT assessment of the bypass valve in ECT patients with comorbid NPH in the literature. Methods: By searching the electronic data bases of PubMed, Google search, Google Scholar, Scopus, and Cochrane Library, we collect data and analyze the pre-ECT evaluation of pacients with NPH and a bypass valve. Results: Of the twelve studies retrieved, none of them had reported neurological symptoms suggestive of valve malfunction like headache or neurological deficits. Although information about the valve examination in the current episode was provided only in the 38.5% of the cases, no bypass valve malfunction was referred among any of the twelve cases, neither before nor during ECT. Conclusions: The available literature on pre-ECT assessment in patients with NPH bypass valve carriers is scarce and the evaluation of the valve functionality has been described in few cases. Although no neurological symptoms of valve malfunction were present and no complications have been described in the current literature during ECT, the clinical guidelines recommend to dismiss the valve malfunction pre-ECT due to the risk of potential herniation, secondary to increased intracranial pressure. [ABSTRACT FROM AUTHOR]