ISSN:1095-0680    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

In 1985, Barker et al. built a transcranial magnetic stimulation (TMS) device with enough power to stimulate dorsal roots in the spine. They quickly realized that this machine could likely also noninvasively stimulate the superficial cortex in humans. They waited a while before using their device over a human head, fearing that the TMS pulse might magnetically “erase the hard-drive” of the human brain. Almost 10 years later, in 1994, an editorial in this journal concerned whether TMS might evolve into a potential antidepressant treatment. In the intervening years, there has been an explosion of basic and clinical research with and about TMS. Studies are now uncovering the mechanisms by which TMS affects the brain. It does not “erase the hard-drive” of the brain, and it has many demonstrated research and clinical uses. This article reviews the major recent advances with this interesting noninvasive technique for stimulating the brain, critically reviewing the data on whether TMS has anticonvulsant effects or modulates cortical-limbic loops.

ISSN:1095-0680    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Magnetic seizure therapy (MST) refers to the use of transcranial magnetic stimulation to induce a seizure for therapeutic purposes. MST is under investigation as a means of improving the safety profile of electroconvulsive therapy (ECT). Although both MST and ECT induce seizures through electrical stimulation of the brain, the electric field induced by MST is more focal and limited than that induced by ECT. Because magnetic fields pass through tissue unimpeded, there is greater control over the site and extent of stimulation with MST than can be achieved with ECT. This enhanced control represents a means of focusing the treatment on target cortical structures thought to be essential to antidepressant response and of reducing spread to medial temporal regions implicated in the cognitive side effects of ECT. MST is currently at an early stage of development. This article reviews the experience with MST in animal models and initial human investigations. Preliminary results have demonstrated the feasibility of performing MST in the clinical setting, and there are suggestions that MST may have advantages over ECT in terms of subjective side effects and some measures of acute cognitive functioning. The antidepressant efficacy of MST is not yet known, but studies designed to address that critical issue are underway. As with all attempts to refine convulsive therapy techniques (such as modifications in stimulation parameter configurations and electrode placement), the ultimate clinical value of MST will need to be established through controlled clinical trials.

ISSN:1095-0680    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Vagus nerve stimulation (VNS) is an established treatment of medically refractory partial-onset seizures. Recent data from an open-label multicenter pilot study also suggest a potential clinical usefulness in the acute and maintenance treatment of drug-resistant depressive disorder. Despite the fact that surgery is needed to implant the stimulating device, the option of long-term use largely devoid of severe side effects would give this treatment modality a privileged place in the management of drug-resistant depression. However, definite therapeutic effects of clinical significance remain to be confirmed in large, placebo-controlled trials. Besides the potential clinical usefulness, VNS can be used as a research tool in epilepsy patients implanted for clinical reasons, allowing neurophysiologic investigations of the parasympathetic system and its interactions with other parts of the central nervous system.

ISSN:1095-0680    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Deep brain stimulation (DBS) is an established therapy for movement disorders and an investigational treatment in other neurologic conditions and in neuropsychiatry. DBS can target with precision neuroanatomical targets deep within the brain that are proposed, on the basis of increasing evidence from functional neuroimaging and other methods, to be centrally involved in the pathophysiology of some neuropsychiatric illnesses. DBS is nonablative, offering the advantages of reversibility and adjustability. In theory, this characteristic might permit therapeutic effectiveness to be enhanced or side effects to be minimized. Although its mechanisms of action are unknown, several possible effects have been proposed to underlie the therapeutic effects of DBS in movement disorders, and potentially in other conditions as well. This issue is the subject of very active investigation in a number of clinical and preclinical laboratories. DBS may offer a degree of hope for patients with intractable neuropsychiatric illness. Research intended to realize this potential will require a very considerable commitment of resources, energy, and time across disciplines including psychiatry, neurosurgery, neurology, neuropsychology, and bioethics. Investigations in this area should proceed cautiously.

ISSN:1095-0680    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

BackgroundAnimal models are frequently used to generate and test hypotheses about amnesia resulting from electroconvulsive therapy (ECT). Although many predictors of ECT-induced amnesia are known, their relative effects have been inadequately researched in the context of the animal models.ObjectiveWe sought to determine the relative retrograde amnestic effects of electroconvulsive shock (ECS) stimulus intensity (dose) and number on strong memories in rats. We also sought to identify dose-dependent ceiling amnestic effects, if any.MethodsAdult rats (n = 144) were overtrained in a passive avoidance task using a step down apparatus. The rats were then randomized in a factorial design to receive one, two, or three once-daily bilateral ECS at 0-mC (sham ECS), 30-mC, 60-mC, 120-mC, or 180-mC doses. Recall of the pre-ECS training was assessed 1 day after the last ECS.ResultsRetrograde amnesia was observed only in rats that received 3 ECS; dose-dependent amnestic effects did not emerge. Higher stimulus intensity was associated with a small (13%) but significant increase in motor seizure duration, but only at the first ECS; stimulus intensity did not influence the attenuation of seizure duration across repeated occasions of ECS.ConclusionWith bilateral ECS, the number of ECSs administered is a more important variable than the ECS dose in weakening a strong, recently acquired, noxious memory; this finding may have important clinical implications. Higher stimulus intensity marginally increases motor seizure duration at the first ECS but does not influence the decrease in seizure duration across repeated ECSs.

ISSN:1095-0680    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Traditionally, psychiatrists have been cautious in administering electroconvulsive therapy (ECT) to patients with recent fractures. Drawing on the collective experience of geriatric psychiatrists in the United Kingdom may allow a better understanding of the use of ECT in fractures. The opinions of UK consultant geriatric psychiatrists on the use of ECT in the presence of recent fracture were acquired by a detailed questionnaire survey. Questionnaires were sent to 551 geriatric psychiatrists, and 306 (56%) usable responses were received. Twelve percent of geriatric psychiatrists had used ECT in fractures, and 55% would be prepared to administer ECT in the presence of fractures. They would seek specialist advice from anesthetists and orthopedic surgeons before, during, and after the administration of ECT. Geriatric psychiatrists generally did not seek advice from specialist ECT consultants. The researchers concluded that geriatric psychiatrists are prepared to administer ECT in the presence of fractures after seeking specialist advice from anesthetists and orthopedic surgeons.

ISSN:1095-0680    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Although electroconvulsive therapy (ECT) is a safe and efficacious treatment, there is a widespread negative view of ECT in public and professional circles. There are no data on Chinese patients' knowledge of, experience with, attitude toward, and level of satisfaction with ECT in Hong Kong. The aims of this study were to examine patients' experience of ECT, and patients' and their relatives' knowledge of, attitude toward, and level of satisfaction with ECT. To this effect, a prospective cross-sectional survey was conducted, involving 96 patients and their 87 relatives. The study showed that the majority of patients believed they had not received adequate information about ECT. The most commonly reported side effect was memory impairment. Patients and relatives had only limited knowledge of ECT, yet the majority of them were satisfied with the treatment and, having found it beneficial, maintained a positive attitude toward its use. The researchers concluded that Hong Kong Chinese patients and their relatives accepted ECT as a treatment. The way information is provided to patients and relatives when obtaining consent for ECT needs improvement.

ISSN:1095-0680    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Agitation is a neurologic complication that may occur after electroconvulsive therapy (ECT). Severe agitation after ECT has been associated with multiple factors, both anesthetic and psychiatric. This case report describes severe postictal agitation after ECT in a patient with bipolar affective disorder. The clinical management of this challenging presentation is discussed, including both the anesthetic and psychiatric approaches.

ISSN:1095-0680    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

The objective is to develop a clinically and ethically supportive literature for the use of electroconvulsive therapy (ECT) in patients with mental retardation who are concurrently experiencing a significant psychiatric illness. A review of both the clinical and ethical literature using traditional, manual library methods and the Medline and Psychlit databases was undertaken. In addition, a record of all patients who had undergone ECT at our facility between 1995 and 2000 was examined for patients with comorbid mental retardation. We found that the use of ECT for people who have both a psychiatric illness and comorbid mental retardation was significantly delayed. However, a rapid response to index, continuation, and maintenance ECT was also noted. Further, this response occurred with routine ECT administered irrespective of age, gender, diagnosis, stimulus parameters, electrode placement, or number of treatments. In addition, the successful use of right-sided unilateral ECT at six times the initial seizure threshold was reported in a patient who had previously responded to bilateral ECT. A cogent ethical justification was developed with the use of the rule of double effect. We concluded that for patients who have mental retardation and who subsequently develop a psychiatric illness, ECT is delayed and left as a treatment of last choice. Although the literature is sparse and uncontrolled, a cogent clinical and ethical justification may help negotiate these and other delays.

ISSN:1095-0680    

出版商:OVID    

年代:2002

数据来源: OVID