{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,20]],"date-time":"2026-10-20T04:38:53Z","timestamp":1792471133138,"version":"4.5.0"},"reference-count":18,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2026,7,29]],"date-time":"2026-07-29T00:00:00Z","timestamp":1785283200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2026,7,29]],"date-time":"2026-07-29T00:00:00Z","timestamp":1785283200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Epilepsia Open"],"published-print":{"date-parts":[[2026,10]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>Electroconvulsive therapy (ECT) is widely used for severe psychiatric disorders, yet concerns remain regarding possible epileptogenic effects associated with prolonged or repeated exposure. We examined the association between cumulative ECT sessions and focal epilepsy in a nationwide Japanese cohort.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a retrospective cohort study using a nationwide claims database including 3733 patients who received ECT between 2008 and 2025. For analyses of incident focal epilepsy, patients with a prior diagnosis of epilepsy before the first ECT session were excluded from the at\u2010risk population. New\u2010onset focal epilepsy was defined as a G40.2 diagnosis recorded after ECT initiation. Person\u2010time accrued from the first ECT session to epilepsy diagnosis or last follow\u2010up. Multivariable logistic regression assessed the association between cumulative ECT sessions and focal epilepsy, adjusting for age, sex, and psychiatric diagnoses. An exploratory time\u2010varying Cox model evaluated cumulative exposure as a time\u2010dependent variable.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Among 3733 patients (mean age 56.9\u2009years; 66.4% female), 96 (2.6%) developed focal epilepsy, corresponding to an incidence of 3748 per 100\u2009000 person\u2010years. A cumulative exposure pattern was observed, with diagnosis rates exceeding 5% among patients receiving \u2265\u200950 sessions and peaking at 9.1% in the 80\u201389 session group. Each additional ECT session was associated with higher odds of focal epilepsy (\n                      <jats:italic>\u03b2<\/jats:italic>\n                      \u2009=\u20090.0099,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.004). Age, sex, and psychiatric diagnoses were not significant predictors. In exploratory time\u2010varying analysis, reaching \u2265\u200950 sessions was associated with increased hazard, although event numbers were limited. Latency to diagnosis ranged from weeks to over 4000\u2009days. Following epilepsy diagnosis, 70.8% discontinued ECT and 98.0% received antiseizure medication.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Significance<\/jats:title>\n                    <jats:p>In this nationwide cohort, greater cumulative ECT exposure was associated with focal epilepsy diagnosis. While causality cannot be established, these findings support consideration of careful neurological monitoring during prolonged ECT courses.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Plain Language Summary<\/jats:title>\n                    <jats:p>Electroconvulsive therapy (ECT) is an effective treatment for severe mental illnesses. However, its long\u2010term neurological effects are not fully understood. We analyzed nationwide data from 3733 patients in Japan who received ECT and examined whether repeated treatments were associated with new diagnoses of focal epilepsy. Ninety\u2010six patients (2.6%) were diagnosed with focal epilepsy after starting ECT. The likelihood of diagnosis was higher among patients who received more ECT sessions, particularly those undergoing prolonged courses. Although this study cannot determine whether ECT directly causes epilepsy, our findings suggest that careful neurological monitoring may be considered during extended treatment.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/epi4.70313","type":"journal-article","created":{"date-parts":[[2026,7,29]],"date-time":"2026-07-29T14:11:36Z","timestamp":1785334296000},"page":"1668-1676","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Cumulative electroconvulsive therapy sessions and focal epilepsy: A nationwide cohort study in Japan"],"prefix":"10.1002","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3837-1504","authenticated-orcid":false,"given":"Masahiro","family":"Hata","sequence":"first","affiliation":[{"name":"Department of Psychiatry Osaka University Graduate School of Medicine  Osaka Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuki","family":"Miyazaki","sequence":"additional","affiliation":[{"name":"Department of Psychiatry Osaka University Graduate School of Medicine  Osaka Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hisaki","family":"Omori","sequence":"additional","affiliation":[{"name":"Department of Psychiatry Osaka University Graduate School of Medicine  Osaka Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shun","family":"Takahashi","sequence":"additional","affiliation":[{"name":"Department of Psychiatry Osaka University Graduate School of Medicine  Osaka Japan"},{"name":"Department of Occupational Therapy, Graduate School of Rehabilitation Science Osaka Metropolitan University  Osaka Japan"},{"name":"Clinical Research and Education Center Asakayama General Hospital  Osaka Japan"},{"name":"Department of Neuropsychiatry Wakayama Medical University  Wakayama Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Manabu","family":"Ikeda","sequence":"additional","affiliation":[{"name":"Department of Psychiatry Osaka University Graduate School of Medicine  Osaka Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,7,29]]},"reference":[{"key":"e_1_2_14_2_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMra2034954"},{"key":"e_1_2_14_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2215-0366(18)30056-7"},{"key":"e_1_2_14_4_1","doi-asserted-by":"publisher","DOI":"10.1038\/209515a0"},{"key":"e_1_2_14_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/0014-4886(66)90129-4"},{"key":"e_1_2_14_6_1","doi-asserted-by":"publisher","DOI":"10.1038\/2141020a0"},{"key":"e_1_2_14_7_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11064-017-2222-z"},{"key":"e_1_2_14_8_1","doi-asserted-by":"publisher","DOI":"10.1136\/jnnp.43.12.1098"},{"key":"e_1_2_14_9_1","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.33.7.921"},{"key":"e_1_2_14_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.brs.2017.11.017"},{"key":"e_1_2_14_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.seizure.2006.12.002"},{"key":"e_1_2_14_12_1","doi-asserted-by":"publisher","DOI":"10.1111\/epi.13565"},{"key":"e_1_2_14_13_1","doi-asserted-by":"publisher","DOI":"10.1002\/epi4.12294"},{"key":"e_1_2_14_14_1","first-page":"303","article-title":"Kindling model of epilepsy","volume":"44","author":"McNamara JO","year":"1986","journal-title":"Adv Neurol"},{"key":"e_1_2_14_15_1","first-page":"1147","article-title":"Long\u2010term risk of epilepsy after traumatic brain injury in children and young adults: a population\u2010based cohort study","volume":"391","author":"Christensen J","year":"2018","journal-title":"Lancet"},{"key":"e_1_2_14_16_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1528-1157.1993.tb02586.x"},{"key":"e_1_2_14_17_1","doi-asserted-by":"publisher","DOI":"10.2188\/jea.JE20220316"},{"key":"e_1_2_14_18_1","doi-asserted-by":"publisher","DOI":"10.1002\/ana.20685"},{"key":"e_1_2_14_19_1","doi-asserted-by":"publisher","DOI":"10.1002\/pcn5.227"}],"container-title":["Epilepsia 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