无抽搐电休克治疗精神分裂症的疗效观察

为观察无抽搐电休克治疗 (ＭＥＣＴ)在治疗精神分裂症中次数与疗效的关系 ,进行本研究。1　对象和方法将 1999年 6月 1日～ 2 0 0 1年 5月 10日接受ＭＥＣＴ的10 0例精神分裂症住院患者随机分成两组 ,Ａ组治疗次数≥ 6次 ,Ｂ组治疗次数 <6次 ,各 5 0例。均符合国际疾病分类第10版和中国精神疾病分类方案与诊断标准第 2版修订本诊断标准 ,排除电休克 (ＥＣＴ)禁忌证。简明精神病评定量表(ＢＰＲＳ)评分≥ 35分。Ａ组 5 0例 ,其中男 2 4例 ,女 2 6例 ;年龄 15～ 6 0岁 ,平均(2 6 4± 9 0 )岁 ;病程 0 1～ 2 8 0年 ,平均 (5 4± 7 1)年 ;偏…     

电休克治疗对近期认知功能影响的相关因素

有人认为 ,几乎所有接受ＥＣＴ治疗的病人在近期内均有认知功能损害[1] 。作者复习了手边有关资料对此作如下综述 ,以供参改。1　电刺激波形对认知功能的影响Ｃｅｒｌｅｔｔｉ和Ｂｉｎｉ(1983)首先使用标准正弦波电流引起抽搐发作 ,后来Ｌｉｂｅｒｓｏｎ和另外一些人提倡用脉冲波代替正弦波来引起发作。借以减少ＥＣＴ对认知功能的损害。而Ｇｏｌｄｓｔｅｉｎ等对正弦波与脉冲波电刺激后的病人分别作了Ｈａｌｓｔｅａｄ -Ｒｅｉｔａｎ成套测验 ,完成“个人记忆”调查 ,对比发现两组对记忆损害均无差异[2 ] 。Ｓｈｅｌ ｌｅｎｂｅｒｇｅｒ发…     

关于电抽搐治疗的探讨

电抽搐治疗（ＥＣＴ）迄今在精神科疾病治疗中仍占重要地位。我们对１９９３～１９９６年期间在本院一个病区的住院患者中符合ＥＣＴ适应症，表现为极度兴奋躁动，冲动伤人，拒食，违拗，紧张木僵，自伤自杀，精神药物治疗无效或对药物治疗不能耐受者３１例进行ＥＣＴ治疗...     

电抽搐治疗精神分裂症时血清催乳素和生互激素水平的改变

使用放射免疫分析法对２３例精神分裂症患者在第１，４，６次电抽搐治疗前，后各１５分钟的血清催乳素和生长激素水平进行了比较研究。结果显示：ＥＣＴ后ＰＲＬ和ＧＨ水平较ＥＣＴ前显著升高，女性患者ＥＣＴ后ＰＲＬ释放值较男性为高，各次ＥＣＴ后ＰＲＬ和ＧＨ的释放值无显著区别；这些提示ＥＣＴ具有神经阻滞剂样抗多巴胺能作用，导致这两种激素水平短暂的升高。     

电抽搐治疗精神分裂症时血清催乳素和生长激素水平的改变

使用放射免疫分析法对２３例精神分裂症患者在第１、４、６次电抽搐治疗（ＥＣＴ）前、后各１５分钟的血清催乳素（ＰＲＬ）和生长激素（ＧＨ）水平进行了比较研究。结果显示：ＥＣＴ后ＰＲＬ和ＧＨ水平较ＥＣＴ前显著升高，女性患者ＥＣＴ后ＰＲＬ释放值较男性为高，各次ＥＣＴ后ＰＲＬ和ＧＨ的释放值无显著区别；这些提示ＥＣＴ具有神经阻滞剂样抗多巴胺能作用，导致这两种激素水平短暂的升高。     

电抽搐治疗电极放置部位对记忆影响的观察

电抽搐治疗电极放置部位对记忆影响的观察山东省济宁市精神病防治院（２７２１５１）栾清明，孙菊，陆继德，宫玉祥，李金丽，刘汝琴电抽搐治疗（ＥＣＴ）引起记忆障碍是公认的，不同电极放置部位对记忆影响的研究，国外有较多报道，其结果不尽一致。为探讨ＥＣＴ不同电极...     

无抽搐电休在治疗半情感障碍的巴金森氏病—身身对照

本文用美多及无抽搐ＥＣＴ治疗５例巴金森氏病伴抑郁发作。进行自身对照观察。结果发现服美多巴后巴金森氏病症状及体征及仅２例好转，抑郁症状无变化；而无抽搐ＥＣＴ治疗后，１例痊愈，３例好转，３例病人抑郁症状缓解。提示无抽搐ＥＣＴ对巴金森氏病伴抑郁发作病人的运动障碍及抑郁症状均有效。     

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...     

改良无抽搐电休克治疗难治性神经症的价值探讨

改良无抽搐电休克治疗难治性神经症的价值探讨赵汉清，于苏文，潘道明，高柏良我们于１９９３年１０月至ｌｏｐ年４月对４例难治性神经症作改良无抽搐电休克法（ＥＣＴ）治疗，旨在了解该疗法的疗效、安全性及患者对治疗的态度。临床资料一般资料４例神经症患者均经长期药...     

低电量电抽搐治疗对急性期精神分裂症女性患者 疗效的单盲随机对照试验

目的 比较低电量电抽搐治疗（LECT）与改良电抽搐治疗（MECT）在治疗女性精神分裂 症的疗效及不良反应方面的差别。方法 将符合入组标准的女性精神分裂症患者随机分为LECT组及 MECT组,每组20 例。LECT组能量设定为2.8 J。常规MECT组能量焦耳数设定为稍大于患者年龄的 1/2。通过阳性与阴性症状量表（PANSS）降分率评估疗效,记录不良反应。结果 LECT 组与MECT 组的 减分数在阴性症状量表上为（3.3±1.5）分、（4.4±2.0）分,差异有统计学意义（t=2.059,P=0.046）,在阳性 症状量表及一般精神病理学量表上分别为（7.1±2.7）分、（9.0±3.8）分及（10.5±3.8）分、（13.0±5.2）分, 差异无统计学意义。LECT组及MECT组出现不良反应人次分别为6 次和58 次,组间差异有统计学意义 （χ2=15.000,P＜ 0.001）。结论 LECT 在疗效上不明显劣于传统诱发抽搐发作电量的ECT,而在不良反 应方面则显著减少。     

Effects of 3 different stimulus intensities of ultrabrief stimuli in right unilateral electroconvulsive therapy in major depression: A randomized, double-blind pilot study

Objective

Efficacy and cognitive outcome of ECT is depending on electrode placement, pulse width and electrical dosage. Several studies showed that high-dosage right unilateral ECT (RULECT) had a better antidepressant effects than low-dosage RULECT and less cognitive side effect than bilateral stimulation. In this prospective, randomized, double-blind trial, we examined the efficacy and cognitive side effects of RULECT with three different (high dose) stimulus intensities (4×, 7× and 10× above the seizure threshold (ST)).

Methods

41 patients with treatment resistant unipolar or bipolar depression were randomized to one of the three stimulation intensities. For stimulation, we used an ultrabrief pulse (0.3 ms). Primary outcome measures were reduction of the Hamilton Depression Rating Scale (HDRS), Beck Depression Inventory (BDI) and the response rate (50% reduction of the HDRS) in the three groups. For cognitive side effects, a neuropsychological test battery was assessed.

Results

All three groups responded significantly to 9 ECTs (p < 0.005), but there were no statistical significant differences in the response rates between the three intensity groups. Besides of the Verbal Learning Memory Recognition Test (VLMT), which showed significant impairments in the high dose intensity groups, no differences could be shown between the three study groups in all neuropsychological tests.

Conclusion

A RULECT with ultrabrief pulse stimulation and 4× ST intensity is effective and from good tolerability. Higher intensity dosages seem to be associated with more cognitive side effects during a course of acute ECT treatment.     

ECT anesthesia: the lighter the better?

BACKGROUND: Electroconvulsive therapy (ECT) is a most effective treatment for patients with major affective disorders. The influence of anesthetic drugs on seizure "adequacy" or on treatment success has not been systematically investigated. METHODS: A bispectral EEG index score (BIS) was used to identify the depth of anesthesia during ECT. Our study included 22 major depressive episode (MDE) patients expanding to 219 ECTs (05/05-01/06) with no limitations of concurrent medication. RESULTS: Fourteen out of the 22 patients showed full remission. Individual number of ECT sessions needed to reach full remission correlated negatively with mean pre-ECT BIS values (p=0.001). Additionally, using a repeated measurement regression analysis significant correlations were found for pre-ECT BIS versus motor response time, seizure concordance, ictal coherence and peak heart rate. CONCLUSION: The results of our study suggest BIS-levels as a predictor of faster ECT response. Controlling BIS-levels before stimulation may have an additional effect on treatment success.     

Relationships between seizure duration and seizure threshold and stimulus dosage at electroconvulsive therapy: implications for electroconvulsive therapy practice

Recent studies cast doubt on the usefulness of seizure duration as an index for stimulus dosage adjustment at electroconvulsive therapy (ECT). A retrospective analysis on the relationships between seizure duration and seizure threshold and stimulus dosage was performed for 54 patients who received a standardized ECT dose titration and treatment protocol. Subjects receiving stimulus dosage at seizure threshold had a highly variable motor seizure duration, ranging from 15 to 89 s, and 7.4% of subjects had seizures longer than 60 s. Regression analysis showed that initial seizure threshold and height were independent predictors of motor seizure duration during dose titration and accounted for 34% of its variance. Stimulus dosage was increased by 40-67% between the first and second ECT session; however, 60% of subjects had no lengthening of seizures and motor seizure duration was significantly shorter at the second treatment (mean +/- SD: 35.7 +/- 12.3 vs 31.0 +/- 10.6 s; paired t = 2.9, d.f. = 34, P = 0.006). At the first and second ECT treatment, motor seizure duration was significantly related to stimulus dosage (r = -0.45 and r = -0.41, respectively). Given the negative correlation between seizure duration and stimulus intensity, a policy that recommends an increase of stimulus dosage and its reduction for patients with short and long seizures, respectively, does not necessarily result in 'optimal' seizure duration. A better dosing policy that places less emphasis on seizure duration is proposed.     

Propofol and methohexital as anesthetic agents for electroconvulsive therapy: a randomized, double-blind comparison of electroconvulsive therapy seizure quality, therapeutic efficacy, and cognitive performance

BACKGROUND: Propofol is often used as an anesthetic agent for electroconvulsive therapy (ECT). Whether the relatively short seizure duration, resulting from the medication, deteriorates the seizure quality and therapeutic outcomes, or whether propofol might be associated with small but significant post-ECT cognitive impairments, is still a subject of controversy. The purpose of our study was to test these hypotheses in comparison with methohexital. MATERIALS AND METHODS: In a double-blind, controlled study, 50 patients with severe major depression who were to be treated with ECT were randomly assigned to anesthesia with propofol (120.9 +/- 50.0 mg) or methohexital (83 +/- 26.3 mg) and were observed for 2 months. The 2 drugs were compared on the basis of electroencephalography-registered seizure duration, mean blood pressure, as well as pulse frequency, seizure efficacy index, and postictal suppression. Systolic and diastolic blood pressure, and seizure duration and quality were recorded consecutively during ECT treatments. Changes in depressive symptoms and cognitive functions were measured at 5 time points, pre-ECT, after the third to fifth ECT, post-ECT treatment, and at a follow-up examination 2 and 8 weeks after the last ECT treatment. RESULTS: Patients on propofol showed a significantly lower increase in blood pressure post-ECT (P < 0.001), their seizure duration was comparable to patients on methohexital (P = 0.072), and seizure quality was significantly superior, as was measured by the Postictal Suppression Index (P = 0.020), and comparable to the methohexital group as measured by the Seizure Efficacy Index (P = 0.160). The improvement of depressive symptoms and the improvement in cognitive functions were similar in both groups (with the exception of the results from 2 cognition tests). CONCLUSIONS: Propofol, as compared with methohexital, results in a more moderate increase in blood pressure and shorter seizure duration. The seizure quality did not differ significantly between the 2 groups. We detected a tendency toward improved cognitive performance after anesthesia with propofol as compared with methohexital, but with statistical significance in only 2 cognition trials. Therefore, propofol is a safe and efficacious anesthetic for ECT treatment.     

The effects of etomidate on seizure duration and electrical stimulus dose in seizure-resistant patients during electroconvulsive therapy

OBJECTIVE: Methohexital used to be the preferred anesthetic used in electroconvulsive therapy (ECT). Since 1999, there have been supply problems for this drug, and there has been no clear guidance regarding which anesthetic should be used preferably in ECT. Most clinics use thiopental or propofol, although these drugs may increase the seizure threshold. We investigated if etomidate improves seizure duration compared with thiopental in cases where eliciting seizures becomes problematic. METHODS: During our routine delivery of ECT at a general psychiatric hospital in Cardiff, UK, we observed 5 patients who had ECT courses with thiopental and did not achieve adequate seizure duration despite very high electric stimulation. They later relapsed and received second courses of ECT under etomidate. We compared the seizure duration and the electric charge needed to produce the seizures for a total of 46 pairs of ECT sessions given under the 2 anesthetics on the same patients. RESULTS: The average electric stimulation dose required to induce seizures was reduced from 638 to 497 millicoulombs (95% confidence interval, 60-221; P = 0.001). Despite the lower dose, the length of observed seizure duration increased by 10.3 seconds (65%) and that of the electroencephalograph-recorded duration increased by 8.7 seconds (41%) (P < 0.001). CONCLUSIONS: Etomidate has a distinct advantage over thiopental in producing seizures of adequate duration during ECT and should be used as the first-line measure in augmenting seizures in patients who have very high seizure thresholds.     

Imaging onset and propagation of ECT-induced seizures

PURPOSE: Regions of seizure onset and propagation in human generalized tonic-clonic seizures are not well understood. Cerebral blood flow (CBF) measurements with single photon emission computed tomography (SPECT) during electroconvulsive therapy (ECT)-induced seizures provide a unique opportunity to investigate seizure onset and propagation under controlled conditions. METHODS: ECT stimulation induces a typical generalized tonic-clonic seizure, resembling spontaneous generalized seizures in both clinical and electroencephalogram (EEG) manifestations. Patients were divided into two groups based on timing of ictal (during seizure) SPECT tracer injections: 0 s after ECT stimulation (early group), and 30 s after ECT (late group). Statistical parametric mapping (SPM) was used to determine regions of significant CBF changes between ictal and interictal scans on a voxel-by-voxel basis. RESULTS: In the early injection group, we saw increases near the regions of the bitemporal stimulating electrodes as well as some thalamic and basal ganglia activation. With late injections, we observed increases mainly in the parietal and occipital lobes, regions that were quiescent 30 s prior. Significant decreases occurred only at the later injection time, and these were localized to the bilateral cingulate gyrus and left dorsolateral frontal cortex. CONCLUSIONS: Activations in distinct regions at the two time points, as well as sparing of intermediary brain structures, suggest that ECT-induced seizures propagate from the site of initiation to other specific brain regions. Further work will be needed to determine if this propagation occurs through cortical-cortical or cortico-thalamo-cortical networks. A better understanding of seizure propagation mechanisms may lead to improved treatments aimed at preventing seizure generalization.     

Seizure threshold manipulation in electroconvulsive therapy via repetitive transcranial magnetic stimulation. A novel way of augmentation?

IntroductionA high seizure threshold (ST) is an impeding factor in certain patients, potentially preventing a successful electroconvulsive therapy (ECT) treatment. Several pharmacological and non-pharmacological methods have been put forward to augment ECT in such patients, however, to this date, only a handful of case reports existed about the potential role of repetitive transcranial magnetic stimulation (rTMS), as an augmentation method.Objectivesand Methods: In this randomized, double-blinded, sham controlled study, we set out to test the hypothesis of whether the application of high frequency transcranial magnetic stimulation (HF rTMS) lowers the seizure threshold for electroconvulsive therapy and whether it has an effect on other aspects of ECT treatment, such as seizure duration (SD), efficacy and safety.Results46 patients treated for a major depressive episode, indicated for ECT, were recruited to this study. A significantly lower seizure threshold was observed in the experimental group during ECT titration, on average a decrease by 34.55%, from 34.23 mC to 22.4 mC, p < 0.001 (Wilcox test). We had not observed a significant effect of TMS stimulation before ECT on seizure duration or clinical outcome. Another potentially important observation of this study is that 4 patients in the experimental group developed transient symptoms of hypomania/mania, all of which were stabilized after the combined stimulation protocol was halted spontaneously within a week, without the need to administer mood stabilizers.ConclusionIt is likely that HF rTMS stimulation prior to ECT is a novel and simple way of reducing the ST, which is useful in certain groups of patients undergoing this important treatment modality.     

Magnetic and seizure thresholds before and after six electroconvulsive treatments

OBJECTIVES: Electroconvulsive therapy (ECT) is a well-established treatment in psychiatry. It has been reported that in patients with nondelusional major depression, transcranial magnetic stimulation (TMS) may substitute for ECT. To explore whether ECT and TMS share mechanisms of action, we studied the effects of ECT on both seizure threshold (ST) and magnetic motor threshold (MT). METHODS: We measured ST and MT in 10 patients referred for ECT. MT was defined as the minimal power of the TMS equipment at which a motor evoked potential (MEP) response could be detected 50% of the time. ST was defined as the minimal intensity of electrical stimulation needed to elicit an adequate seizure. ECT was performed following the methods recommended by the American Psychiatric Association. All subjects signed an informed consent for participation in the research. RESULTS: We measured MT and ST in 10 patients before and after 6 ECT treatments. No changes in MT were detected from the treatment (paired t-test: t = 1.05, SD = 4.78, p = 0.25). ST, on the other hand, increased significantly with treatment (paired t-test: t = 2.99, SD = 190.20, p < 0.001). CONCLUSIONS: ECT and TMS do not share a common mechanism at least with regard to MT and ST.     

Antiepileptic drug withdrawal in childhood: does the duration of tapering off matter for seizure recurrence?

There is no consensus on how long the duration of antiepileptic drug withdrawal after seizure control should be. The objective of the present study was to verify if the duration of tapering off matters for seizure recurrence in children with controlled epilepsy. In this prospective study, patients were randomized to taper the antiepileptic drug during a period of 1 or 6 months. Fifty-seven patients met the inclusion criteria; 24 were girls, and ages ranged from 2 to 16 years (mean 9.45 years). There was no difference between the two groups according to age, gender, type of epileptic syndrome, electroencephalogram abnormality, and antiepileptic drug (P > .05). In the 1-month group, seizure recurred in 10 patients, as opposed to 12 patients in the 6-month group. The analysis of seizure recurrence in each group showed no difference (P > .05). We conclude that the duration of antiepileptic drug tapering off does not influence the risk of seizure recurrence in childhood.