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

Forty-six patients were studied with N-isopropyl I-123 p-iodoamphetamine (IMP) and the Harvard Scanning Multidetector Brain System. In nine control patients, good differentiation between the gray and white matter of the cerebral cortex and the basal ganglia was evident. Regional uptake was affected by physiologic maneuvers (visual stimulation). In 24 patients studied for stroke, IMP images demonstrated areas that were involved in acute infarction in eight patients whose initial transmission computerized tomography (TCT) was normal; IMP also showed perfusion abnormalities larger than the TCT abnormality in ten patients. Perfusion abnormalities were present in 23/24 of these patients. Seven patients studied with a history of TIA had normal TCT and IMP images. In three patients studied during seizure activity, regions of hyperperfusion corresponded to the EEG seizure focus. Markedly decreased activity was present in three patients with brain tumor and corresponded to the focal abnormality on the TCT study. Our study demonstrates the feasibility of assessing regional brain perfusion using a radiopharmaceutical that is lipid soluble and has a high extraction fraction in the brain, together with single-photon ECT.
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PMID:Initial experience with SPECT (single-photon computerized tomography) of the brain using N-isopropyl I-123 p-iodoamphetamine: concise communication. 697 24

ECT is an effective psychiatric treatment for severe depression, mania, catatonic states, and, to a lesser degree, some schizophrenias. Complications are minimal and the risk of death extremely low, lower than that for an inadequately treated depression. However, some medical centers in the United States do not use ECT at all. The neurochemical mechanisms that underlie ECT remain unknown, but a cerebral seizure is essential. The average number of treatments is seven, spread over two to three weeks. All candidates for ECT should undergo a complete medical evaluation and give informed consent.
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PMID:A review of the use of electroconvulsive therapy. 709 69

EEG monitored ECT was administrated to 20 patients, 12 females and 8 males. One hundred and fifty-six treatments were given (mean 7.8 treatments/patient), and the relation between clinically observed seizures (COS) and the cerebral patterns of convulsions (EPC) was compared. If clinical observation alone had been used, restimulation would have been necessary in 43 per cent of the treatments, whereas restimulation actually was done in 9 per cent. Similarly, too violent convulsion patterns would have been ignored in 5 per cent of the treatments.
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PMID:EEG monitored ECT. 711 61

This paper reviews the special indications for ECT. Included among these are delusional depression, affective illness which occurs in the geriatric population, depressions which are not responsive to pharmacologic intervention; depressed manic or schizophrenic patients who do not tolerate medication side effects; and drug-refractory Parkinson's disease. Technological advantages which have increased the safety of the procedure while reducing the side effects include: brief pulse electrical stimulation of the seizure, nondominant unilateral placement of electrodes, and simultaneous monitoring of EEG and EKG during the procedures. Finally, the five steps designed to address psychological issues as they relate to ECT are outlined and ECT is placed into the perspective of an overall therapeutic strategy in treating the patients.
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PMID:Electroconvulsive therapy in the eighties: technique and technologies. 714 86

Computer assisted energy-spectral analyses were obtained on EEG recordings of unilateral non-dominant hemisphere ECT-induced seizures using the different pre-ECT anesthetic agents methohexital (Brevital), Innovar, and ketamine (Ketalar). The previously postulated predominance of electrical energy over the stimulated (right) hemisphere early in ECT-induced seizures is confirmed. There appears to be marked reduction in total seizure energy with methohexital anesthesia, whereas ketamine anesthesia appears to be associated with increased overall seizure energy. The greatest right to left energy transfer during the seizure occurred with Innovar anesthesia.
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PMID:The electroencephalographic pattern during electroconvulsive therapy II. Preliminary analysis of spectral energy. 717 56

An intraindividual, double-blind crossover comparison of the retrograde effect on memory of unilateral nondominant fronto-frontal and temporo-parietal ECT was performed in connection with the second and third treatments of an ECT series. Treatment technique was standardized and seizure duration was measured by means of EEG. Memory functions were examined 1 hr before and 2 hr after ECT. Three operationally defined memory variables: immediate memory, delayed memory, and their difference, forgetting, were scored. There were no differences between fronto-frontal and temporo-parietal ECT in regard to the amount of methohexital and suxamethonium chloride employed, the mean time of electrical stimulation, and the seizure duration. There were significantly higher delayed memory and lower forgetting scores after fronto-frontal electrode placement.
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PMID:The effect of fronto-frontal and temporo-parietal unilateral ECT on retrograde memory. 722 76

electrical seizure activity induced by ECT appears in three phases: Phase I initial 18-22 Hz. (beta-like) activity, Phase II arrhythmic polyspike activity, and Phase III rhythmic 2 1/2-3 1/2 Hz. spike/polyspike-wave activity. With bitemporal ECT, Phase II activity appears simultaneously in all leads. With unilateral non-dominant hemisphere ECT, there is an orderly march on Phase II polyspikes from the right anterior temporal region. After termination of a seizure, there is symmetrical suppression of normal activity with bitemporal ECT, but with unilateral non-dominant hemisphere ECT there is less suppression of normal activity in the unstimulated side.
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PMID:Electroencephalographic recording during bitemporal and unilateral non-dominant hemisphere (Lancaster Position) electroconvulsive therapy. 724 Jan 12

EEG and EMG were monitored simultaneously at 72 ECT sessions in 18 patients. When EMG was recorded from the leg the duration of EMG curve convulsions varied between 43 and 89% of the EEG recorded seizure duration of the same fit. The EMG/EEG seizure ratio varied widely among different patients as well as within the single patient during a series of ECT sessions. EMG recording from the masseter muscles showed EMG seizure duration to be more in accordance with the EEG seizure duration than EMG recordings from the leg. The EMG/EEG seizure ratio (masseter) varied from 65 to 100%, which was significantly higher than the EMG/EEG seizure ratio obtained with EMG recorded from the calf muscles. The use of EEG monitoring of ECT is advocated in order to obtain the most precise evaluation of the cerebral seizure activity. If EEG monitoring is not available EMG recorded from the masseter muscles provides a reasonably accurate and easily applicable method of monitoring the presence and duration of the ECT-induced seizure.
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PMID:Electroconvulsive therapy: a comparison of seizure duration as monitored with electroencephalograph and electromyograph. 732 90

The effects of stimulus parameters and electrode placement upon ECT seizure threshold were investigated in 40 psychiatric inpatients referred for ECT treatment, using EEG monitoring of seizure activity. Overall, brief pulse stimuli were found to require approximately one-third as much stimulus energy as sine wave stimuli in producing equivalent suprathreshold seizures. For brief pulse stimuli, unilateral nondominant electrode placement, utilizing a parieto-frontotemporal arrangement, was associated with a slightly lower seizure threshold than for bilateral electrode placement. For sine wave stimuli, on the other hand, no difference in seizure threshold on the basis of electrode placement was found, although unilateral electrode placement as associated with briefer seizures. The implications of these findings in terms of clinical efficacy and CNS side effects are discussed.
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PMID:ECT and seizure threshold: effects of stimulus wave form and electrode placement. 741 13

Prior studies have shown that in younger depressives undergoing ECT whose seizure durations declined despite maximum settings on three different ECT devices, pretreatment with caffeine lengthened seizures and resulted in clinical improvement. Caffeine (half life, 140-270 minutes) was well tolerated even in patients with pre-existing cardiovascular disease. The purpose of this retrospective study was to determine the safety and efficacy of caffeine augmented ECT in elderly depressed patients. The charts of 14 elderly depressives (average age 75.6, range 59-83; 2 males, 12 females) who received caffeine-augmented ECT were reviewed. Patients pre- and post-ECT medications, blood pressure, pulse, and seizure times (cuff and EEG) for each ECT performed were noted. The following conclusions were drawn from our study: (1) Caffeine definitely increases the seizure length and was useful in our setting when the energy settings could not be increased anymore. (2) Caffeine augmentation inconsistently causes an increase in pulse rate, on average, in the elderly. (3) Caffeine inconsistently produces an increase in mean arterial pressure. (4) Caffeine did not consistently produce an increase in the maximum rate-pressure product. We conclude from this study that caffeine-augmented ECT is safe and effective in increasing seizure duration in the elderly. However, more research needs to be done to determine optimal dosing and tolerability.
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PMID:Safety and efficacy of caffeine-augmented ECT in elderly depressives: a retrospective study. 757 41


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