EEG immediately after unilateral ECT

EEG was continuously recorded in 15 patients for a period extending from just before to 1/2 hour after unilateral ECT. Fourier analysis was performed on the EEG following 15 right-sided treatments and five left-sided treatments. During the induced seizure, epileptic slow-wave activity had significantly greater power on the treated side. Immediately after the seizure, there was significantly more delta activity and less alpha and beta activity on the treated side. This asymmetry, though becoming less marked, was usually still present at the end of the recording period. Analysis of other variables associated with the treatment showed that there was a significant correlation between the time to eye-opening after ECT and both the duration of the seizure and the amount of anaesthetic administered. The similarity between these induced unilateral seizures and unilateral seizures occurring spontaneously in some epileptics is discussed.     

Case report of lateralized affective states immediately after ECT

Dysphoric states were observed in a patient immediately after right unilateral and bilateral ECT, while euphoric states followed left unilateral ECT, suggesting that disruption of lateralized neural mechanisms may have been involved in the pathophysiology of the affective states.     

Transient visual loss after right unilateral ECT

We report a case of transient bilateral visual loss in a 27-year-old patient with a diagnosis of bipolar disorder after right unilateral electroconvulsive therapy that occurred immediately after her first session and resolved within 24 hours. We discuss possible mechanisms for this adverse effect.     

ECT and Neurological Disorders

Clinicians become concerned when ECT is contemplated in an individual with a neurological disorder. In this review, the authors summarize the reports on the use of ECT in the presence of neurological disease. Because blood pressure, cerebral blood flow, and intracranial pressure rise with ECT, space-occupying lesions with increased intracranial pressure, cerebral aneurysm, recent head trauma, or active CNS infection pose special concerns for ECT treatment. In this review, we conclude that epilepsy and states with lowered seizure threshold may predispose to prolonged seizures. A history of head injury or stroke probably does not increase risk. Toxic/metabolic disorders are not contraindications to ECT, although correction of the underlying imbalance is a first priority. Extrapyramidal, demyelinating, and neuromuscular disorders pose little increased risk. Indeed, in Parkinson's Disease, ECT may be beneficial for the motor symptoms. As a general rule, it seems advisable to treat the underlying disorder prior to beginning ECT.     

Therapeutic results in brief-interval unilateral ECT.

The study reported comprised 104 patients with endogenous depression who were given unilateral electroconvulsive therapy (ECT). The patients were divided into two equally large groups, one receiving two and the other four treatments per week. The latter group was selected openly, while the former had been collected by a double-blind technique on a previous occasion. The severity of depression was assessed before the first treatment and on the days after the sixth and the last treatment, and at these times memory testing by WMS Forms I and II and EEG were also performed. An analysis is presented of the therapeutic effect obtained, assessed by: (1) the number of treatments applied in the two groups; (2) the reduction in the depression score; and (3) the effect achieved per treatment. In the group with frequent electrostimulation one to two addititional treatments were required, the difference being statistically significant. On the other hand, frequent stimulation tended to be more effective in terms of the reduction in the depression score. The effect per treatment was identical in the two groups. Four treatments per week did not result in a higher frequency of complications. A comparison of the five severest depressions in each of the two groups did not reveal any difference in the therapeutic effect of the two methods of treatment. It is concluded that the technique with four treatments per week instead of two offers the advantage that the duration of the treatment period is reduced by 11-12 days. As the study also revealed that the discomforts, including memory impairment, are not increased by frequent stimulation, it is recommended that unilateral ECT is administered with a frequency of four treatments per week.     

Attentional asymmetries following ECT in patients with major depression.

Neuropsychological abnormalities of lateralization have been reported after right unilateral electroconvulsive therapy (ECT), that may reflect temporary disruption of the treated hemisphere. A visuospatial task sensitive to lateralization of spatial attention was administered in a test-retest design to patients with unipolar major depression and a group of age and gender matched controls. The patient group underwent right unilateral ECT between the two test sessions. The patient and control groups did not differ significantly at the initial baseline testing. After ECT, the patient group showed a significant shift of attentional bias toward the left, while the control group showed no significant shift in the second session relative to the first. The results suggest that approximately 1 h after termination of ictus there is a leftward attentional bias, possibly reflecting a change in right hemisphere cerebral activity.     

Left unilateral electroconvulsive therapy (ECT) after oligodendroglioma resection

A 44-year-old man with a previously resected right parietal oligodendroglioma received left unilateral electroconvulsive therapy (ECT). We present images of his brain magnetic resonance imaging, ECT electrode placement, and the electroencephalogram tracing from his ECT.     

Comparison of fronto-frontal and temporo-parietal unilateral ECT.

An intraindividual double-blind cross-over comparison for the anterograde effect on memory of unilateral non-dominant frontofrontal (FF) and temporo-parietal (TP) ECT was performed in connection with the second and third treatment of an ECT-series, the electrode placement being alternated at random. Treatment technique was standardized and seizure duration was measured by means of EEG. Memory functions were tested after treatments by means of four memory tests: the 30 Word-Pair Test, the 30 Figure Test, the 30 Geometrical Figure Test and the 30 Face Test. Three operationally defined memory variables, immediate memory (IMS, 3 hours after ECT), delayed memory (DMS, 3 hours after IMS), and their difference, forgetting, were scored. No differences were found in the mean time of electrical stimulation, in the amount of methohexital and suxamethonium chloride, and in seizure duration between the two treatment groups. No statistically significant differences in any of the memory tests were found. The FF electrode position did not show any advantage compared with the routine TP electrode placement.     

Multiple EEG examinations in patients with refractory endogenous depression after unilateral ECT

In 37 inpatients /27 females and 10 males, mean age--49.8 +/- +/- 10.3 years/, with the diagnosis of refractory endogenous depression, after completing a course of unilateral ECT /u-ECT/, multiple EEG examinations were performed during a year of observation. Routine EEG examinations were carried out after a washing out period of two weeks, using an 8 channel Medicor-Orion EEG device. The patients were examined before treatment and 2, 4 and 6 weeks and then 3, 6 and 12 months after the course of ECT. The mean number of ECT which the patients received during a therapeutic session was 8.4 +/- +/- 2.8. Two weeks after completing the course of U-ECT, pathologic tracings in the EEG were found in 17 patients--mainly slowing of the basic alpha activity and slow theta waves. A month after the course of U-ECT in the majority of patients--32 there was a normal EEG tracing. After 6 weeks changes in EEG were found in 2 patients. In one of them they were still present after completion of U-ECT. No significant relationship between the persistence of EEG changes and the number of U-ECT received during the last therapeutic session or the quantity of ECT treatments in the past was detected. The result of this work may support the hypothesis that changes in the biological activity of the brain after ECT therapy are reversible in nature and most probably are a reflection of functional changes in the neurons, partly connected with the therapeutic process or without any relationship with that occurring from a wide spectrum of neurochemical activity of the method of treatment.     

Postural asymmetries following unilateral subthalomotomy for advanced Parkinson's disease.

Two cases of postural asymmetries following unilateral stereotaxic subthalamotomy were observed with head and body tilting to the side contralateral to the STN lesion, which corrected itself completely or partially with levodopa treatment. After subsequent contralateral STN surgery, the postural asymmetry disappeared in both patients. Possible mechanism is discussed.     

Cerebral blood flow and neuropsychological asymmetries in unilateral stroke.

BACKGROUND AND PURPOSE: This study sought to determine the degree of agreement between asymmetries of neuropsychological functioning and nine methods of quantifying asymmetries of regional cerebral blood flow. METHODS: The regional cerebral blood flow methods combined three markers of cerebral blood flow asymmetry (percent hemispheric difference, maximum percent probe-pair asymmetry, and number of probe-pair asymmetries) with three indexes of regional cerebral blood flow (fast compartment flow, initial slope index, and initial slope). Eleven patients with left hemispheric ischemic strokes and 13 with right hemispheric ischemic strokes were studied with the xenon-133 inhalation technique and neuropsychological tests. RESULTS: Blind clinical judgments of neuropsychological asymmetry significantly correlated with all nine methods of cerebral blood flow asymmetry determination; correlations ranged from -0.42 to -0.77. Clinical judgment of asymmetry of neuropsychological functioning accurately predicted the hemisphere of lower flow in 71-92% of cases, depending on the method of cerebral blood flow asymmetry determination. Agreement between cerebral blood flow and neurobehavioral signs of asymmetry was greater for initial slope and initial slope index than for the fast flow index. The initial slope and initial slope index showed equally good agreement. The use of the number of asymmetrical probe pairs to detect cerebral blood flow asymmetries agreed less well with neurobehavioral asymmetry than did the other two markers studied. CONCLUSIONS: Both the initial slope index and the initial slope measures of cerebral blood flow are useful in predicting neuropsychological asymmetries, especially when the magnitude of the asymmetry is taken into account.     

Resuming electroconvulsive therapy (ECT) after emergence of asymptomatic atrial fibrillation during a course of right unilateral ECT

Atrial fibrillation induced by electroconvulsive therapy (ECT) is rare, with only 3 reported cases. None of those cases involved either young healthy patients or right unilateral ECT. We report a 46-year-old healthy male observed to be in atrial fibrillation immediately after electrical induction of the 25th administration of right unilateral ECT. Diltiazem was administered, and he spontaneously cardioverted. After a negative cardiology workup, he safely resumed ECT. Atrial fibrillation was most likely triggered by autonomic imbalance due to the combination of electrical induction, seizure, and medication.     

Evoked potentials following unilateral ECT. I. The somatosensory evoked potential

The somatosensory evoked potential (SEP) was recorded in 14 patients undergoing unilateral ECT for the treatment of depression. All patients received right-sided ECT. One patient was studied on a second occasion during leftsided ECT. The index and middle fingers of each hand were electrically stimulated 1/sec throughout anaesthesia, the fit and the 0.5 h period following the fit. During barbiturate anaesthesia the SEP showed the characteristic change of the P49 component and enhancement of P32, while during the seizure induced by right ECT, the SEP was seen more clearly on the left side of the head, despite the high voltage epileptic activity. No significant asymmetries of any of the SEP components were seen post-ictally, the response returning rapidly on both sides. The subjective threshold to electrical stimulation of the fingers of each hand was significantly raised following ECT.