ISSN:1095-0680    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

Many patients who receive electroconvulsive therapy (ECT) are benzodiazepine dependent or are anxious and require benzodiazepine drugs. Because these agents may diminish the therapeutic effectiveness of ECT, we explored the dosing, safety, and efficacy of pre-ECT flumazenil administration, a benzodiazepine-competitive antagonist, in patients receiving benzodiazepine medications. We report our experience with 35 patients who received both flumazenil and benzodiazepine drugs during their ECT course. We compared seizure duration with and without flumazenil and compared treatment efficacy to 49 patients who received ECT without either of these medications. Flumazenil could be safely administered with ECT. A few subjects taking higher chronic benzodiazepine dosages experienced breakthrough anxiety or withdrawal symptoms, which were well managed by dosing flumazenil immediately before the anesthetic agent and by immediate posttreatment benzodiazepine administration. A dose of 0.4–0.5 mg was adequate for all but those taking the highest benzodiazepine dosages, where 0.8–1.0 mg resulted in a clinically more effective reversal. No differences in efficacy or seizure duration were found as a function of flumazenil administration. Flumazenil offers the promise of safe and effective ECT in patients receiving benzodiazepine drugs. Follow-up outcome investigation on a random assignment basis will be necessary for definitive assessment of the value of flumazenil. In addition, the direct effect of benzodiazepine drugs and the flumazenil/benzodiazepine combination on ECT seizures remains to be determined.

ISSN:1095-0680    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

We investigated the effect of electroconvulsive treatment (ECT) on platelet14C-serotonin uptake,3H-paroxetine binding and 5-HT2receptors in 12 patients (10 women and 2 men) unresponsive to pharmacological treatment. The mean numbers of ECTs given was 6.1 ± 1.5. Mean treatment days was 14.6 ± 3.8. Mean percent reduction in MADRS scores was 80.7 ± 19.7 (p <0.002). The number of 5-HT2receptors increased significantly and uniformly after ECT (p = 0.011). There was no correlation between the degree of increase in 5-HT2receptor densities and the reduction in MADRS scores after ECT. There was no difference in mean Bmaxfor platelet3H-paroxetine binding before and after ECT. Bmaxincreased in six patients and decreased in six patients. The study shows an increase in platelet 5-HT2-receptor densities in depression after repeated ECT. Recognizing the similarities between 5-HT2receptors in platelets and cerebral cortex, it seems reasonable to assume that a similar upregulation of cortical 5-HT2receptors occurs after ECT.

ISSN:1095-0680    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

Motor threshold is a means of quantifying stimulus in transcranial magnetic stimulation. Two methods are used. One involves neurophysiology techniques and the other is visualization of movement. The aim was to compare the percentage of total machine output (PTMO) necessary to achieve motor threshold using these different methods. Neurophysiological and visualization of movement thresholds were determined in six subjects. In all subjects, the two thresholds were achieved with a <10% difference in PTMO. Determination of motor threshold with a neurophysiological and a visualization of movement method produced similar results.

ISSN:1095-0680    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

In a randomized crossover study, the influence of the anesthetics methohexital and propofol on EEG seizure parameters, seizure-quality measures, vital signs, and oxygen saturation (Spo2) and end-tidal carbon dioxide tension (ETco2) was investigated; 146 treatments of 31 patients were analyzed. Significant differences were observed between agents for mean postictal pulse and blood pressure values. With methohexital, there was a clear postictal increase of mean blood pressure from 126/78 mm Hg to 161/102 mm Hg, whereas there was no increase with propofol (p= 0.00), and with methohexital, a postictal increase of the mean pulse rate from 81 to 90 beats/min and a slight decrease with propofol (79 to 78 beats/min). There were no differences in the Spo2and ETco2. The mean seizure duration for unilateral treatments was significantly longer with methohexital (52.7 s) compared with propofol (34.1 s;p= 0.000), but there was no difference for the seizure-quality measures: postictal suppression index (propofol 79.7%, methohexital 77.4%) and mean integrated amplitude (30.2/31.8) were the same for both anesthetic agents. The results show that differences in seizure duration are unrelated to seizure-quality measures.

ISSN:1095-0680    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

A case report of outpatient maintenance electroconvulsive therapy (ECT) is presented in a patient with bipolar disorder type I refractory to conventional medication treatment but responsive to ECT. A cost comparison is made showing substantial savings when outpatient maintenance ECT is used in lieu of inpatient hospitalization with ECT. A detailed life chart illustrating multiple medication trials that failed to stabilize the patient accompanies the financial summary. This case highlights the advantages of outpatient maintenance ECT for bipolar depression particularly with regard to safety, efficacy, and significant health care cost reduction.

ISSN:1095-0680    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

We report the case of a 58-year-old woman with depression and hypertension in whom aphasia, right-sided hemiparesis, and a possible right visual field defect were identified during recovery from right unilateral electroconvulsive therapy (ECT). The neurologic deficits resolved over a 3-day period; the patient was diagnosed with a reversible ischemic neurologic deficit (RIND). Review of the pertinent literature suggests that such cerebrovascular events in the setting of ECT are extremely rare and possibly decreasing in frequency. Reasons for such a decrease may include improved screening for predisposing cardiovascular conditions and the widespread use of neuromuscular blockade, ventilatory support, and cardiovascular monitoring during the procedure. Prompt recognition of cerebrovascular events is important to prevent complications such as cerebral edema, seizures, and aspiration, as well as to use new treatments for stroke.

ISSN:1095-0680    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

We report a 66-year-old woman with a cerebellar meningioma who successfully received electroconvulsive therapy (ECT) for mania. No special modifications in technique were required. A growing literature supports the relative safety of ECT in patients with small, stable brain tumors.

ISSN:1095-0680    

出版商:OVID    

年代:1998

数据来源: OVID

ISSN:1095-0680    

出版商:OVID    

年代:1998

数据来源: OVID

ISSN:1095-0680    

出版商:OVID    

年代:1998

数据来源: OVID