ISSN:1095-0680    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

ObjectiveMissed or abortive seizures during electroconvulsive therapy (ECT) may preclude completion of an effective course of treatment in some cases. Seizure augmentation, using proconvulsant agents, has been used to overcome resistance to the induction and continuation of seizure activity. In this review, we analyze published clinical data on the effects and safety of seizure augmentation techniques.MethodClinical studies and case reports were obtained through a MEDLINE literature search from 1966 to 2001, cross-referencing ECT and proconvulsant agents. Article references were also scanned for relevant studies.Results and ConclusionsData from clinical trials indicate that augmentation facilitates seizure induction when maximal electrical stimuli fail. Anesthetic modifications, including hyperventilation and substitution with etomidate, ketamine, or other agents, often are successful in overcoming seizure resistance and compare favorably with the use of caffeine. In a few studies, augmentation enabled the use of lower stimulus intensities and fewer treatments without loss of efficacy, even in patients not resistant to seizure induction. However, effects of proconvulsants must be reconciled with increasing evidence of the importance of stimulus dosing relative to seizure threshold and other parameters, now considered key to the efficacy of ECT. Further investigations of pharmacologic augmentation could facilitate the administration of ECT and could provide further insights concerning parameters of seizure efficacy and the mechanism of action underlying convulsive therapies.

ISSN:1095-0680    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Right unilateral (RUL) ECT is reported to have fewer memory side effects than bilateral (BL) ECT. We compared RUL ECT at eight times the seizure threshold (ST) against BL ECT at 1.5 times the ST. Adults with major depression were randomly assigned to RUL ECT at eight times ST or BL ECT at 1.5 times the ST. Blinded ratings of mood and memory were made before ECT, 1 to 3 days after the final ECT, and at 2 and 4 weeks after ECT. Forty patients received RUL and 37 received BL ECT. The antidepressant response rate was not significantly different for the RUL and BL groups (60% vs. 73%). Sustained antidepressant response, accompanied by recovery from anterograde memory side effects, was seen through the first month with both treatments. Measures of mood and memory were not significantly different for the two groups at any time point. The modest sample sizes of this study do not rule out a type II error in the detection of small but meaningful differences between assigned treatments. Also, the period of post-ECT observation consisted of 1 month of naturalistic treatment. Both RUL ECT at eight times the ST and BL ECT at 1.5 times the ST produce similar mood and memory effects. Both forms of ECT produced acceptable antidepressant response rates and only transient anterograde amnesia. No clear advantage emerged for either form of ECT, and both are justifiable as first-line techniques of ECT.

ISSN:1095-0680    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Electroconvulsive therapy (ECT) is still the fastest, most effective, and frequently life-saving therapeutic intervention in several forms of depression and some other psychiatric disorders. Transient memory disturbances are frequent after ECT. A randomized, double-blind, placebo-controlled study was conducted to investigate the effects of piracetam on ECT-induced confusion and memory disturbances. Thirty-eight consecutively admitted patients with depressive illness or schizophrenia requiring ECT were given either piracetam or an identical-looking placebo during the period of ECT treatment and for 2 weeks afterward. Daily dosage of piracetam was 7.2 g, given orally for the first 2 weeks while patients underwent ECT (loading phase), followed by 4.8 g for the rest of the study period. Participants were evaluated by standardized clinical rating scales and cognitive psychologic tests 1 to 2 days before ECT, 1 day after their third and sixth ECT treatments, and 2 weeks after they had completed their ECT courses. Piracetam had no significant effect in preventing ECT-induced memory disturbances. All clinical ratings were consistently, albeit not significantly, better in the piracetam group, suggesting that piracetam may have augmented the effects of ECT.

ISSN:1095-0680    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

In this study we investigated whether electroconvulsive stimuli (ECS) altered the regional brain protein concentrations of nerve growth factor (NGF), brain-derived neurotrophic factor (BDNF), and glial cell line-derived neurotrophic factor (GDNF) in Sprague Dawley rats. Electroconvulsive stimuli were administered once daily for 8 days. At the end of the experiment, rats were killed, the brains were dissected into five regions, and the neurotrophic factors were extracted and measured by enzyme-linked immunosorbent assay. Electroconvulsive stimuli increased the concentrations of NGF in the frontal cortex and concentrations of BDNF in the hippocampus, the striatum, and the occipital cortex. In contrast, ECS decreased GDNF concentrations in the hippocampus and the striatum. Our data indicate that neurotrophic factors play a role in the mechanism of action of ECS and, by extrapolation, may play a role in the mechanism of action of electroconvulsive treatment.

ISSN:1095-0680    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

BackgroundStimulus intensity during electroconvulsive therapy (ECT) is reckoned in units of charge (mC). The values of pulse amplitude, pulse width, pulse frequency, and stimulus duration can be varied to yield different composite stimuli, all of which have the same charge. There is little information on the extent to which variations in these stimulus parameters influence the seizure threshold at constant charge in the context of ECT.MethodsWe administered once daily electroconvulsive shocks (ECS) to two groups of rats, starting with a stimulus intensity of 1 mC and increasing in 1 mC steps until the thresholds of each of three different types of seizure were identified. In one group (n = 10), the charge was raised first by increasing pulse amplitude and later by increasing pulse frequency. In the other group (n = 10), the charge was raised by increasing the stimulus duration only.ResultsThe mean seizure threshold ranged from 8.4 to 11.4 mC, depending on the type of seizure described, in the group in which pulse amplitude and frequency were manipulated; this range was 2.5 to 5.5 mC in the group in which the stimulus duration was manipulated (p < 0.001 for each of three types of seizures). Rats (n = 7) that did not convulse with an 8-mC stimulus in the amplitude and frequency group all convulsed with a 5-mC stimulus from the stimulus duration schedule. The first manifestation of seizure activity was significantly less likely to be generalized with amplitude and frequency titration than with stimulus duration titration (20% vs. 90%, respectively). The mean motor seizure durations (at different thresholds) were comparable with the two methods of stimulus titration.ConclusionsSeizure thresholds are lower when stimulus duration is the parameter that is increased during dose titration. The many clinical implications of this finding require study.

ISSN:1095-0680    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Continuation and maintenance electroconvulsive therapy (ECT) is used to reduce the risk for relapse and recurrence of illness in patients who fare poorly with continuation and maintenance medication regimens. Despite the potential value of these ECT schedules, both are relatively neglected in clinical practice. This article therefore reviews the last decade of research on the subject. Although the research comprises mostly single and multiple case reports and small open studies, continuation and maintenance ECT does emerge as a safe and effective treatment for relapse- and recurrence-prone patients who have responded to a course of ECT.

ISSN:1095-0680    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Literature on the treatment of rapid cycling bipolar disorder is scant. This report describes a case of rapid cycling bipolar disorder successfully treated with ECT. The patient showed a complex combination of pathologic features not unusual in clinical practice.

ISSN:1095-0680    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

We report the case of an 81-year-old woman, suffering from a major depressive episode and incipient Alzheimer disease, whom we treated with ECT without interrupting therapy with the acetylcholinesterase inhibitor (ACHE-I) rivastigmine. After eight right unilateral ECT sessions, the patient remitted completely without any significant deterioration of memory and cognitive abilities or cholinergic side effects. This report demonstrates that ECT was safely used in one elderly and mildly demented person with continuous ACHE-I therapy. The hypothesis that this drug may indeed protect against unfavorable side effects of ECT should be further tested in clinical trials.

ISSN:1095-0680    

出版商:OVID    

年代:2002

数据来源: OVID

ISSN:1095-0680    

出版商:OVID    

年代:2002

数据来源: OVID