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Query: UMLS:C0036572 (seizures)
 80,221 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The noncontroversial fact regarding ECT seems to be that controversy exists in almost every area of its use, its art, and its science. The nature of the treatment itself, its history of abuse, unfavorable media presentations, special attention by the legal system, uneven distribution of use among facilities and practitioners, and lack of certified standards for psychiatric training in ECT have tended, in the past 2 decades, to swing the pendulum towards the use of tricyclic and other antidepressant agents for the treatment of severe depression. Despite recommendations for continual review of data and of clinical and research experience, few pertinent reports by anesthesiologists have appeared. Guidelines for the anesthesiologist have not been established. Due to the pervading presence in earlier studies of hypoxia, hypercarbia, and acidosis, it is futile to compare findings of unmodified ECT to modified ECT. More recent studies relating especially to cardiovascular abnormalities have also been difficult to evaluate because of widely varying formats, use of different agents and dosages, continuance or discontinuance of psychotropic drugs, and variability of ventilation and concentrations of oxygen. ECT is a modality that has not outlived its usefulness. With proper pretreatment, selection and evaluation of patients, use of appropriate modification techniques, and careful clinical management and monitoring during treatment, ECT can be both safe and effective, even in relatively high-risk patients. ECT provides an exciting challenge for concerned physicians to explore the role of brain function and behavior, and the effects of seizures on neuroendocrine mechanisms, neurohumoral mechanisms, cerebral metabolism, the blood-brain barrier, and ion transport systems. It may lead to further understanding of the action of general anesthetics, CNS depressant drugs, and the effects of stimulation of the central autonomic nervous system and the endocrine systems. A close interaction between basic and clinically oriented researchers holds the key to designing studies that can answer these critical questions, rather than continuation of studies that merely generate more data.
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PMID:Electroconvulsive therapy--1987. 330 31

This double-blind, random-assignment study contrasted the relative efficacy of bilateral and unilateral right ECT with a low-dose titration procedure. In 52 patients with primary major depressive disorder, bilateral ECT was markedly superior in short-term symptom reduction to unilateral right ECT. The two conditions did not differ in the duration of generalized seizures or in the number of treatments administered to achieve clinical response. The findings challenge the claim that the elicitation of generalized seizure is, in and of itself, sufficient for the antidepressant properties of ECT. Rather, a dose in excess of seizure threshold may contribute to the efficacy of ECT, particularly with a unilateral right electrode placement.
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PMID:Effects of electrode placement on the efficacy of titrated, low-dose ECT. 331 38

There are correlations between schizophrenia and the limbic seizure system on the one hand and the manic-depressive or bipolar syndromes and the generalized seizure system on the other hand, which are theoretically related to the different (although overlapping) neural substrates underlying the two major syndromes of psychosis. Evidence is reviewed that indicates that in ECT-responsive depression (with both bilateral and unilateral nondominant ECT) the modus operandi hinges on right-hemispheric neural events. At the same time the relevance of the complex interactions existing between limbic and generalized seizures, REM suppression, right limbic epilepsy and REM activation is discussed as well as the role of carbamazepine in these interactions.
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PMID:[Cerebral mechanisms of the efficacy of electroshock therapy]. 345 May 4

The neurophysiological systems subtending generalized seizures (activated by ECT) and temporal-limbic seizures are described as well as the interactions existing between the two seizure systems. There are correlations between schizophrenia and the limbic seizure system on the one hand and the manic-depressive or bipolar syndromes and the generalized seizure system on the other which are theoretically related to the different (although overlapping) neural substrates underlying the two major syndromes of psychosis. Evidence is reviewed that indicates that in ECT-responsive depression (with both bilateral and unilateral nondominant ECT) the modus operandi hinges on right-hemispheric neural events. Neurophysiological, neurological, and acoustic threshold evidence is discussed: all of which emphasizes the importance of the nondominant hemisphere in the genesis of endogenous depressions and in their treatment with convulsive therapies. In addition, studies showing that psychotropic agents with specific antidepressant effects produce asymmetric activation of the right hemisphere (EEG) are related to the above issues.
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PMID:Electroconvulsive therapy and lateralized affective systems. 351 73

In 34 patients with primary, major depressive disorder, randomly assigned to bilateral or right unilateral ECT, heart rate (HR) and blood pressure (BP) were assessed prior and following seizure induction at every treatment. In contrast to prior reports, no cumulative pattern was observed in HR or BP changes as a function of treatment number. Generally, treatment variables, including ECT modality (bilateral vs. unilateral), anesthetic agent (methohexital vs. pentothal), and prior subconvulsive stimulation in a session, had no effects on the magnitude of peak postictal increases in HR or BP. The peak changes were also unrelated to the history of cardiac illness, remission of depressive symptomatology, patient seizure threshold and patient seizure duration. Pre-treatment HR was strongly predictive of peak postictal change in both HR and BP, while pretreatment BP was not. Patients with high pre-ECT HR had smaller peak postictal HR and BP increases. The findings suggested that low dosage, titrated ECT has HR and BP effects similar to traditional high dosage techniques, and that pre-treatment HR is the best predictor of these effects.
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PMID:Acute effects of ECT on cardiovascular functioning: relations to patient and treatment variables. 359 19

An intraindividual, double blind cross-over comparison of the retrograde effect on memory of unilateral non-dominant fronto-frontal (FF) and temporo-parietal (TP) ECT was performed in connection with the second and third treatments of ECT-series. Treatment technique was standardized and seizure duration was measured by means of EEG. Memory functions were examined 1 hour before and 2 hours after ECT with four tests. The influence on forgetting over this time was taken as a measure of the memory disturbance. There were no differences between FF and TP ECT as regards the amount of methohexital and suxamethonium chloride, mean time of stimulation and seizure duration. The influence of forgetting was similar in all memory tests. The result is in agreement with a previous anterograde study. It is concluded that no essential gain in terms of reduced memory disturbance can be obtained by substituting the routine non-dominant temporo-parietal with fronto-frontal electrode positions.
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PMID:Comparison of fronto-frontal and temporo-parietal unilateral non-dominant ECT. A retrograde memory study. 359 25

During a course of ECT, seizure duration may become too brief for clinical benefit. Use of higher-energy stimuli may lengthen seizures but may also increase the risk of toxicity, and it is not possible when maximum settings are reached. The authors present the cases of six drug-free depressed inpatients whose seizure durations in ECT declined despite maximum settings on three different ECT devices. In all cases, pretreatment with caffeine lengthened seizures (mean increase = 107%), and clinical improvement followed. Caffeine was well tolerated, even in patients with cardiovascular diseases.
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PMID:Use of caffeine to lengthen seizures in ECT. 363 12

In this study, eight patients participated in a standardized protocol to assess the effects of caffeine on seizures in ECT. Caffeine sodium benzoate (500-2000 mg) was administered intravenously 10 minutes before ECT, and seizure duration was compared with that of a previous treatment unmodified by caffeine. Seizure duration was significantly increased during ECTs preceded by caffeine. Three other patients given caffeine when seizures of adequate duration could no longer be elicited at maximal stimulus levels experienced longer seizures. Administration of caffeine was not associated with significant cardiovascular or other (including cognitive) adverse effects.
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PMID:Facilitation of ECT by caffeine pretreatment. 363 18

The influence of arterial O2 and CO2 tensions on electroconvulsive seizure duration was investigated in five mongrel dogs under consistent anaesthetic conditions. Seizure durations were measured in a randomized protocol of nine possible combinations of arterial gas tension spanning increased, normal or decreased levels of PaO2 and PaCO2. Seizure duration was directly related to PaO2 (p less than 0.00001) and inversely related to PaCO2 (p less than 0.0001). A significant synergism was evident at the extremes of PaO2 and PaCO2, with seizure duration being greater than predicted for hyperoxia-hypocapnia and hypoxia-hypercapnia and shorter than predicted for hypoxia-hypocapnia and hyperoxia-hypercapnia. We conclude that arterial gas tensions strongly influence ECT-induced seizure duration and through this may influence the therapeutic efficacy of electroconvulsive therapy.
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PMID:Arterial PaO2 and PaCO2 influence seizure duration in dogs receiving electroconvulsive therapy. 366 9

The correlation coefficients among four different measures of seizure duration (motor activity, EEG spikes, EEG total, tachycardia) were substantially lower with unilateral than bilateral ECT. This suggests that unilateral ECT is less well generalized through the brain than bilateral ECT.
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PMID:Generalization of the effects of unilateral and bilateral ECT. 372 21


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