Clinicians become concerned when ECT is contemplated in an individual with a neurological disorder. In this review, the authors summarize the reports on the use of ECT in the presence of neurological disease. Because blood pressure, cerebral blood flow, and intracranial pressure rise with ECT, space-occupying lesions with increased intracranial pressure, cerebral aneurysm, recent head trauma, or active CNS infection pose special concerns for ECT treatment. In this review, we conclude that epilepsy and states with lowered seizure threshold may predispose to prolonged seizures. A history of head injury or stroke probably does not increase risk. Toxic/metabolic disorders are not contraindications to ECT, although correction of the underlying imbalance is a first priority. Extrapyramidal, demyelinating, and neuromuscular disorders pose little increased risk. Indeed, in Parkinson's Disease, ECT may be beneficial for the motor symptoms. As a general rule, it seems advisable to treat the underlying disorder prior to beginning ECT.