ISSN:1095-0680    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

The seizure threshold to electroconvulsive therapy (ECT) is defined entirely by the duration of the induced seizure, is multidetermined, and varies enormously with a wide variety of patient and treatment factors, including especially the parameters of the ECT stimulus. No consistent relationship has ever been detected between the clinical antidepressant response to ECT and either the threshold or the duration of the induced seizure.The stimulus titration method for determining the seizure threshold (titration–threshold dosing) was the central research tool used to reverse years of dogma by proving that the induced seizure of ECT is not alone sufficient to explain the therapeutic properties of ECT, and that the interaction between dosage and treatment electrode placement is critical in this regard. In clinical use, however, titration–threshold dosing has proven less than fully effective in optimizing the stimulus dose for ECT—better results are consistently obtained with age-based or fixed high-dose methods.The lack of a direct correlation between either seizure threshold or duration and clinical ECT response is an irremediable flaw of the titration–threshold method as clinically applied. New approaches are now called for in which ECT stimulus dosage is set and adjusted (“titrated”) according to the clinical antidepressant response of the patient or to measurable correlates thereof: maximum sustained electroencephalogram (EEG) ictal power, EEG postictal suppression, induced interictal EEG delta activity, peak heart rate, maximum sustained EEG coherence, and postictal EEG coherence reduction, all of which have been found by various investigators to be related to the clinical antidepressant response to ECT.

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

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

ISSN:1095-0680    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

ObjectiveTo determine the safety, efficacy, and effects on glycemic control of electroconvulsive therapy (ECT) in insulin-requiring type 2 diabetic patients.MethodsChart review was conducted of 19 patients with insulin-requiring type 2 diabetes mellitus who underwent ECT at Mayo Clinic (Rochester, Minnesota) between 1993 and 2000. None of the patients received oral hypoglycemic drugs. Daily fasting blood glucose concentrations and daily insulin requirements were determined. For each patient, the daily insulin requirements before the first ECT treatment were compared with insulin requirements after the last ECT treatment. In addition, the insulin requirements 1 day before and 1 day after each ECT treatment (n = 143) were compared. Charts were reviewed for activity, appetite, and weight changes.ResultsThe average change in daily insulin requirements 1 day before the initiation of ECT compared with 1 day after the completion of ECT was not statistically significant. Changes in dietary or activity levels correlated with fluctuations in insulin requirements in selected individuals. There were no significant changes in acute glycemic control associated with ECT.ConclusionsOur findings refute previous reports of dangerous hyperglycemia or improved glycemic control due to ECT in insulin-requiring type 2 diabetes, and suggest that ECT is safe and efficacious in these patients.

ISSN:1095-0680    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

IntroductionOf 58 patients treated at our electroconvulsive therapy (ECT) unit early in the year 2000, 12 patients under propofol did not achieve a seizure duration of >30 s [electroencephalogram (EEG)] with a maximum stimulation charge of 504.0 mC (100%).MethodA switch from propofol to etomidate was therefore undertaken in these patients at the next treatment to achieve longer seizure duration.ResultsIn 11 of the 12 patients, a remarkable increase in seizure duration was recorded after the change of anesthetic. The mean seizure duration increased from 18.6 to 43.4 s and remained at that level for the following ECT session. The increase was highly significant (t11= 3.772, p < 0.001). The mean motor seizure also changed from 11.6 to 27.5 s (t11= 5.560, p < 0.003) and remained there for the next treatment.DiscussionOur data show that the switch more than doubles EEG seizure duration and suggest that etomidate can be used instead of methohexital as an alternative in patients with short seizure duration. It is also a potential option to avoid the pain frequently associated with the injection of propofol.

ISSN:1095-0680    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

The short-term outcome of electroconvulsive therapy (ECT) was studied in 24 patients with a current major depressive episode (DSM-IV). Patients were randomized to high dose (400% above the seizure threshold) right unilateral (RUL) ECT, to moderate dose (150% above seizure threshold) RUL ECT, and to low dose (just above seizure threshold) bifrontal (BF) ECT. Primary outcome measures included number of treatments, Hamilton Depression Rating Scale score, and Mini-Mental State Examination score. High dose RUL ECT was associated with a significantly faster response to treatment than low dose BF ECT. Moreover, there was a tendency to a higher response rate with high dose RUL ECT compared with either moderate dose RUL ECT or BF ECT.

ISSN:1095-0680    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

A selected electroconvulsive therapy stimulus dose can result from different combinations of pulse amplitude, pulse width, pulse frequency, and stimulus duration; however, the roles of these stimulus variables in the effects of the overall stimulus dose are not clearly understood. A series of studies on Wistar rats was therefore conducted to assess the effects of different stimulus compositions at constant stimulus charge. In the first two studies, two differently composed 60 mC charge unidirectional electroconvulsive shock (ECS) stimuli were administered once daily for 3 days, while in the third study three differently composed 120 mC charge unidirectional ECS stimuli were administered on a single occasion. At constant charge, a markedly longer stimulus duration was associated with ear burns and an approximately 12.5% longer seizure duration. At constant charge, however, different stimulus compositions were not associated with different degrees of impairment in two passive avoidance models of ECS-induced retrograde amnesia. These preliminary findings have implications for the choice of stimulus settings during dose titration and dose selection procedures. While the findings encourage further investigation, it appears that variations in stimulus duration are biologically significant, but minor variations in other stimulus elements may not influence the effects of electrically induced seizures very much.

ISSN:1095-0680    

出版商:OVID    

年代:2002

数据来源: OVID