安定对电抽搐治疗通电时间和睡眠的影响

安定对电抽搐治疗通电时间和睡眠的影响广西贵港市解放军１９１医院（５３７１０５）鲍忠城黎若云邹华根李志生１９９０年本院曾作安定（ＤＺＰ）对电抽搐治疗（ＥＣＴ）脑电图（ＥＥＧ）改变的研究（《广西精神卫生》总１６期，１９９０，１－２；全国神经及精神疾病诊疗...     

改良电痉挛疗法治疗100例精神病的疗效及其相关因素分析

目的探讨改良电痉挛疗法治疗精神病疗效及其相关因素的影响。方法将我院１９９９年１～５月期间,所有接受改良电痉挛疗法治疗１００例精神病患者（４２６例次）的临床资料进行总结分析。结果总有效率９０％。其中以抑郁症疗效量好（１００％）,其次为躁狂症（９３．３％）、精神分裂症（８３．９％）。三组患者的疗效存在非常显著性差异。无一例出现严重的合并症。疗效与累积发作时间仅在六次治疗组存在显著性相关,而与电量、通电     

磁极化量子血治疗偏头痛150例疗效观察

我科采用磁极化量子血治疗偏头痛１５０例，临床效果满意，现报告如下：1 临床资料1．１ 一般资料 １５０例中女１１０例，男４０例，年龄最小 ２３岁，最大６５岁；病程最短半年，最长２０年；治疗次数最少３次，最多１２次，一般治疗６次即可。1．２ 治疗方法 取患者静脉血１５０～２００ｍｌ，经体外抗凝，注入装有磁棒的石英瓶中，放入带有磁场的治疗仪内，通电启动开关，同时充氧（５升／分），紫外线光照，１５ｍｉｎ后血液由暗红转为鲜红，立即回输给病人，隔日一次，６次为一疗程。1．３ 疗效评定标准 根据症状、体征消失情况，分为…     

飞速发展的世界神经外科学-记第13届世界神经外科大会(下)

（续上期） 四、功能神经外科 （一）癫痫的手术治疗（孙振荣综述） 本次大会上有十几篇论文从不同角度论述了癫痫的手术治疗。共同的结论是：（1）对顽固性癫痫病人进行外科治疗是有效的；（2）在手术治疗顽固性癫痫过程中，术前评估，特别是对癫痫的定位是非常关键的。     

电休克治疗致延迟性心跳、呼吸骤停一例

患者 男，37岁，身高178cm，体质量98kg。精神分裂症病史10年，因幻觉、妄想伴冲动破坏行为等精神症状于2004年12月24日入院。患者平素睡眠时打鼾，经常在睡眠中突然端坐并大口喘气。入院后给予电休克治疗1次／d（双颞侧，电流强度100mA，通电时间3s），无合并用药。2004年12月30日行第4次治疗，经过顺利，自主呼吸恢复好，随后进入痉挛后的朦胧期。约5min后突发心跳、呼吸停止。立即给予人工心肺复苏，5rain后出现140～160次／min的窦性心律和不规则、微弱呼吸，2min后心跳、呼吸再次停止，     

茴三硫（胆维他）治疗慢性酒精中毒的临床对照研究

目的：探讨胆维他对慢性酒精中毒的治疗价值，寻找一种安全有效的戒毒方法。方法：采用在逐渐断酒及对症处理基础上的解毒治疗（胆给他）与替代治疗（佳静安定）的病例对照研究方法。结果：解毒治疗（胆维他）组与替代治疗（佳静安定）组总体疗效相近，且前者副反应较少，肝功能改善好，结论：胆维他可用于慢性酒精中毒的治疗，特别适用于伴有肝脏损害（如酒精性肝病）者，是一种安全有效的解毒药物。     

X-刀单次与分次治疗垂体腺瘤的疗效分析

目的探讨垂体腺瘤行x-刀单次治疗与分次治疗后疗效与并发症的差异。方法回顾性分析121例经x-刀治疗的垂体腺瘤病人的临床资料，根据治疗方式不同分为单次治疗组（70例）与分次治疗组（51例），比较两组疗效及并发症发生率的差异。结果治疗后总体肿瘤控制率为95．9％，其中单次治疗组肿瘤控制67例（95．7％），分次治疗组肿瘤控制49例（96．1％）；治疗后激素水平控制率为38．0％，其中单次治疗组激素水平控制28例（40．0％），分次治疗组激素水平控制18例（35．3％）；两组肿瘤控制和激素水平控制差异均无统计学意义（P〉0．05）。而治疗后两组1、2、3级并发症发生率差异均有统计学意义（P〈0．05）。结论适当的治疗间隔时间的分次治疗是降低并发症的可靠方法。     

影响全身惊厥性癫痈持续状态治疗效果相关因素的研究

目的：探讨影响全身惊厥性癫痫持续状态（GCSE）治疗效果的相关因素，为临床诊治提供理论依据。方法：回顾性分析37例GCSE患者的治疗过程。将治疗效果分为显效（完全控制不复发）、有效（发作频率明显减少，症状减轻）和无效（发作频率和症状无明显变化，甚至加重）。对性别、年龄、病因和治疗延迟与治疗效果的关系用Logistic逐步回归，向前逐步法进行多因素分析。结果：性别（OR=12．798，95％CI：3．329-49．199）、年龄（OR=0．784，95％CI：0．681-0．902）、病因（OR=5．958，95％CI：2．324-7．750）和治疗延迟的时间（OR=1．153，95％CI：1．034-1．286）是影响GCSE治疗效果的因素。结论：GCSE早期治疗是预防发作时间的延长和复发，改善治疗效果的重要环节。     

急性重型颅脑损伤后急性肺损伤和急性呼吸窘迫综合征的治疗体会

目的探求急性重型颅脑损伤后急性肺损伤（ALI）和急性呼吸窘迫综合征（ARDS）的发病机理、诊断和治疗。方法对39例急性重型颅脑损伤（GLS〈8）后并发ALI／ARDS患者的临床资料进行回顾性分析，及早采用综合治疗方案，气管切开，机械通气，早期大剂量甲基强的松龙，沐舒坦，纳洛酮，脱水，抗感染，消化道去污染，早期肠内营养，合理的容量支持等治疗。结果随访3个月，以GOS分级法评价病人预后：Ⅰ级死亡8例（20％），Ⅱ级植物生存1例（3％），Ⅲ级重残4例（10％），Ⅳ中残3例（7％），Ⅵ级良好23例（60％）。结论ALI／ARDS是重型颅脑损伤后危及生命的严重并发症，系多种因素诱导的一个病理过程。针对器官及功能进行支持治疗，特别是呼吸支持是ARDS治疗的主要手段。     

240例植物状态临床治疗分析

目的：探讨植物状态患（Vegetative state,VS)临床康复治疗方法和效果，治疗效果与病程、年龄的关系。方法：我院从1991年5月－2002年8月采用综合促醒及康复手段治疗VS患240例，这些患均符合我国VS诊断标准（1），其中持续一个月以上的VS诊断为持续性植物状态（Persistent Vegetative state,PVS)患212例。按我国诊断标准分型，完全性植物状态（CVS）166例，不完全性植物状态（IVS）74例。治疗方法为一般治疗（整体护理，营养，预防治疗并发症）、促醒治疗（高压氧，声光电刺激，中药促醒I、Ⅱ、Ⅲ、Ⅳ号，西药手术等）和康复治疗（运动疗法、作业疗法、语言治疗、日常生活能力训练和针灸按摩等）。结果：基本痊愈47例（19．6％），明显好转64例（26．7％），好转80例（33．3％），无效46例（19．2％），死亡3例（1．3％）。发病3个月内治疗65例，基本痊愈26例（40％），而发病12个月以上只1例（20％）。15岁以下11例，痊愈5例（45％），而30岁以下患126例中痊愈29例（23％）；30－60岁的99例中痊愈18例（18％），而60岁以上无1例痊愈。结论：临床综合治疗对VS患有肯定的治疗效果；病程愈短、年龄愈小疗效愈显。     

Electric Acupuncture Convulsive Therapy

In 150 schizophrenic patients, a comparative investigation between electric acupuncture convulsive therapy (EACT) and electroconvulsive therapy (ECT) showed that the current used for eliciting a convulsion in EACT was only 3.6% of that for ECT when the electrodes were placed at acupoints Baihui and Renzhong. EACT is a modification of ECT in which stimulating currents are passed through acupuncture needle electrodes inserted in midline positions. In this study, the efficacy of EACT was better, the somatic and visceral reactions milder, and the incidence of spine fracture and changes in EEG and in memory were less than in ECT. The clinical efficacy of electroconvulsive therapy is seen to depend on changes in midline brain structures.     

Predictors for the efficacy of electroconvulsive therapy: chart review of a naturalistic study

BACKGROUND: Several variables have been suggested that can predict the efficacy of electro-convulsive therapy (ECT) in patients suffering from depression. The results of studies into these predictors for ECT efficacy are not consistent. METHOD: In a retrospective chart review of patients suffering from major depressive disorder and bipolar disorder according to DSM-IV criteria who have been given ECT in a psychiatric hospital in the Netherlands, predictors for ECT efficacy were explored. Information was gathered for predictors including sex, age, diagnosis, presence of psychosis, duration of index episode, medication treatment failure prior to ECT, medication during ECT course, and ECT variables. ECT was given twice weekly from November 1997 to June 2002. The 17-item Hamilton Rating Scale for Depression (HAM-D) was applied at baseline and weekly during the course. RESULTS: Seventy-three patients suffering from unipolar or bipolar depression were given ECT in the study period, with 56 patients (77%) meeting antidepressant treatment history form criteria for medication treatment failure. With remission defined as a reduction of depressive symptoms of at least 60% from baseline and a HAM-D end score of less than 8, 48 patients (65.8%) remitted. Forward stepwise logistic regression analysis selected only duration of index episode as a significant predictor for ECT efficacy. Medication treatment failure was not found to be a significant predictor. The concurrent use of psychotropic medication during ECT did not influence the efficacy. CONCLUSION: Duration of index episode was the only variable found to significantly predict the efficacy of ECT.     

Evaluation of the combination of tryptophan and ECT in the treatment of depression. I. Clinical analysis.

A double-blind evaluation of the antidepressant efficacy of treatment with a combination of orally administered L-tryptophan (L-TP) and electroconvulsive therapy (ECT) was made in patients suffering from endogenous depression. The patients were randomly assigned to two groups, one treated with L-TP (6 g daily) and unilateral ECT, the other with placebo and unilateral ECT. L-TP treatment was initiated at least 1 day before the first ECT and terminated 4 days after the last ECT. There was a good agreement between the two groups in several measures of antidepressant efficacy: doctors' and patients' ratings of depressive symptoms, and doctors' global rating of therapeutic effect 4 days and 1 month after the last ECT. In the L-TP group, however, there was a significantly better effect on retardation symptoms in the nurses' rating scale. This difference, which is not consistent with other measures of amelioration, contributes, at most, to a marginal therapeutic addition to the antidepressant effect of ECT. It is concluded that oral administration of L-TP, in the dose of 6 g daily, is not of practical value for potentiating the antidepressant efficacy of ECT.     

Moderate clinical improvement with maintenance ECT in a 17-year-old boy with intractable catatonic schizophrenia

The use of electro-convulsive therapy (ECT) in adolescents is controversial, and few studies have been conducted to assess its efficacy and safety in this population. We report the case of a 19-year-old boy who received two series of ECT, one at 15 and another at 16, for intractable catatonic schizophrenia. Since the age of 17, he has required treatment combining clozapine and maintenance ECT. The course showed a sustained moderate improvement. The treatment permitted the patient to regain some autonomy with moderate adverse effects. ECT remains an uncommon treatment in adolescents, and the current case supports the view that it should not be banned in young people.     

The efficacy and safety of ECT in depressed older adults: a literature review

BACKGROUND: Although little doubt exists among practising clinicians in old age psychiatry about the efficacy and safety of ECT in depression, opinions about acceptability differ widely. The objectives of this review were to determine the efficacy and safety of ECT based on both randomised and non-randomised evidence in elderly with a major depressive disorder. METHODS: Randomised and non-randomised studies on efficacy and safety of ECT in elderly with and without concomitant disorders such as cerebrovascular disorders, Alzheimer's dementia, vascular dementia and Parkinson's disease were selected. Literature was systematically searched in a number of electronic databases. RESULTS: Although 121 studies were included in the review process, only four provided randomised evidence. No negative studies with respect to efficacy were found. ECT is effective in the acute treatment of late life depression. ECT is generally safe, although a number of serious complications possibly related to ECT have been described. Most of the objectives of this review could not be answered or refuted with certainty, because firm randomised evidence on the efficacy and safety of ECT in the depressed elderly is missing. CONCLUSIONS: ECT is effective in the acute treatment of late life depression and is generally safe. Important questions such as the relative efficacy of ECT over antidepressants, the long-term efficacy of ECT, morbidity and mortality related to ECT, cost-effectiveness and the efficacy of ECT in subgroups of patients cannot be answered and need to be studied further.     

Efficacy of continuation ECT and antidepressant drugs compared to long-term antidepressants alone in depressed patients

OBJECTIVE: The purpose of this study was to evaluate the efficacy of continuation ECT in depression. METHOD: The authors used retrospective chart review to identify 29 patients who received continuation ECT plus long-term antidepressant treatment after a positive response to acute treatment with ECT for a depressive episode (continuation ECT group). A retrospective case-controlled approach was used to ascertain a matching group of 29 patients who received long-term antidepressant treatment alone after responding positively to acute ECT (antidepressant-alone group). All 58 patients (46 with unipolar depression, 12 with bipolar disorder) had been chronically depressed before receiving acute ECT. Data from medical records were analyzed by using survival analysis and proportional hazards regression to determine outcome and risk factors. RESULTS: The mean duration of the follow-up period for all patients was 3.9 years (5.4 years for the continuation ECT patients and 2.4 years for the antidepressant-alone patients). Outcome was significantly better in the continuation ECT group. The cumulative probability of surviving without relapse or recurrence at 2 years was 93% for continuation ECT patients and 52% for antidepressant-alone patients. At 5 years, survival declined to 73% for continuation ECT patients, but fell to 18% for antidepressant-alone patients. Mean survival times were 6.9 years for the continuation ECT patients and 2.7 years for the antidepressant-alone patients. CONCLUSIONS: The findings provide strong support for the efficacy of continuation ECT plus long-term antidepressant treatment in preventing relapse and recurrence in chronically depressed patients who have responded to acute treatment with ECT.     

Remifentanil supplementation of propofol during electroconvulsive therapy: effect on seizure duration and cardiovascular stability

OBJECTIVES: Electroconvulsive therapy (ECT) is standard treatment of severe depression. The induction of a seizure is a core event in successful ECT. Although propofol is a frequently used anesthetic agent, one of its limitations is a reduction of seizure duration. No such effects have been reported regarding remifentanil, an ultrarapid-acting opioid that is used to induce and maintain anesthesia. The simultaneous administration of propofol and remifentanil may have similar safety and efficacy in terms of induction of anesthesia during ECT as propofol alone and significantly increase seizure duration. METHODS: Twenty-one ECT patients (10 men, 11 women, aged 24 to 81 years) were recruited. Muscle paralysis was achieved with succinylcholine (0.5-0.75 mg/kg intravenously [IV]). Unconsciousness was induced by either propofol (1 mg/kg IV) or propofol (0.5 mg/kg IV) + remifentanil (1 microg/kg) in a crossover format. ECT was administered according to established clinical protocols at the Sheba Medical Center, Israel. No changes in ECT current were permitted in the 2 protocols of each patient. Statistical analysis was based on paired t tests. RESULTS: In all but 2 cases, seizure duration was significantly longer in the remifentanil group than in the control group (motor seizure 53.7 +/- 28.3 seconds vs. 29.5 +/- 10.9 seconds, t = 4.017, P = 0.0007; Electroencephalographic (EEG) seizures 60.8 +/- 25.1 seconds vs. 40.1 +/- 17.0 seconds, t = 3.971, P = 0.001). No significant differences were found in mean recovery time, post-treatment elevation in blood pressure, heart-beat, or oxygen saturation. CONCLUSION: During anesthesia, the addition of remifentanil to propofol appears to be as effective as propofol alone with regard to anesthesia efficacy and cardiovascular function while significantly increasing seizure duration. Whether this discovery is of relevance to the clinical efficacy of ECT remains to be tested.     

Missed and brief seizures during ECT: differential response between unilateral and bilateral electrode placement

The number of electroconvulsive therapy (ECT) stimulations over a course of treatment that resulted in brief or no seizure activity was evaluated for depressed patients (N = 58, treated for DSM-III diagnosed major depressive disorder) who had been randomly assigned to either bilateral or unilateral nondominant ECT in a double-blind study. Comparable treatment efficacy between both groups was found. Although there were no group differences in brief seizures, unilateral nondominant ECT resulted in more missed seizures (p less than 0.01) and required more restimulations than bilateral ECT. Of 27 unilateral ECT patients, 63% had at least one missed seizure over the course of treatment, compared to 29% of 31 bilateral ECT patients (p less than 0.02). Although more missed seizures occurred early in treatment, brief seizures occurred later in treatment. As missed seizures are not always detected clinically, it is possible that without seizure monitoring, patients with unilateral nondominant ECT will not improve at the same rate as patients with bilateral ECT. Lack of seizure monitoring in the clinic is one likely explanation for the discrepancy between a number of research studies reporting equivalent efficacy for bilateral and unilateral ECT and the clinical impression that bilateral ECT is more effective.     

ECT versus transcranial magnetic stimulation (TMS): preliminary data of computer modeling

The essential issue of electroshock therapy (ECT) is the activity of physical stimulus, i.e., the electric current, on the disturbed structures of the brain. ECT sessions--when chronically applied for evoking antidepressive effects--are responsible for the appearance of excessive incitement in the neuronal net in the brain tissue in a form of self-sustaining after-discharge (SSAD) (convulsive attack characteristic for ECT). The study presents the computer research on basic biophysical phenomena of electroshock therapy (flow of electric current in the structures of the head just before convulsive attack). Five-layer 3-D model of the head was created in OPERA-3D (Vector Fields Ltd., Oxford), general 3 dimensional issues solver. Geometrical dimensions and electrophysical properties of each layer correspond with natural properties. The model was subjected to the action of electric stimulation (parameters identical to those applied in clinical conditions). Analysis of the flow in particular layers revealed the crawling/spreading effect present not only in the scalp layer but also in the layer of cerebrospinal fluid. The effect is conditioned by "deeper situated" lesser conduction of electricity-respectively skull bones, brain tissue. Crawling effect is the reason why only 5-15% of the electricity applied on the surface of the head reaches the surface of the brain. Electro-stimulation examinations also showed that the values of the so called density of the current in layers of brain tissue balanced between 1-10 mA/mm2. The current parameters of ECT were effective in evoking subsequent convulsive attack and safe for the brain tissue. The model was subjected to the action of magnetic stimulation according to the parameters of neurologic technique of transcranial magnetic stimulation (TMS). ELECTRA module was used to solve wire-current issues. The examination showed more regular distribution of current vectors in all layers of the head. The density of cerebral cortex was 0.1-1 mA/mm2, confirming markedly lesser current charge than that observed during ECT. The problem of magnetic stimulation efficacy in irritating deep structures of the brain demands further studies.