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

Relative stimulus intensity above seizure threshold has been shown to affect therapeutic outcome with unilateral ECT. The authors sought to explore whether a multivariate ictal EEG model would permit ongoing clinical assessment of this parameter. Twenty-five depressed subjects were randomized to either barely (T) or moderately (2.5T) suprathreshold ECT treatments. Seizures in 2.5T subjects had significantly greater ictal spectral amplitude and coherence, greater postictal suppression, and shorter latency until ictal slow-wave onset. A multivariate logistic regression ictal EEG model distinguished between stimulus intensity groups with 90% accuracy. Preliminary evidence suggests a relationship between several ictal EEG indices and therapeutic outcome. A multivariate ictal EEG algorithm holds promise as a tool for clinical determination of adequate stimulus intensity with unilateral ECT.
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PMID:The ictal EEG as a marker of adequate stimulus intensity with unilateral ECT. 758 Jan 87

A patient who presented with seizures, opisthotonos, catatonia, and autonomic dysfunction developed features consistent with sporadic encephalitis lethargica. She received a course of ECT and had full recovery.
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PMID:Sporadic encephalitis lethargica: a case treated successfully with ECT. 762 70

Electroconvulsive therapy is one of the most useful, safe and predictable treatment modalities in psychiatry. For optimal results proper application of the procedure is essential. Over the years the procedure has undergone considerable refinement, yet not all those who administer the treatment are fully conversant with this. This paper addresses issues relating to electrode placement, stimulus dosing and seizure monitoring from practical and clinical points of view. Right unilateral ECT, if administered with high electrical stimulus, produces results close to bilateral treatment with substantially less cognitive impairment. However, certain patients may only respond to bilateral ECT. Adequate training for clinicians administering ECT is recommended.
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PMID:Electrode placement, stimulus dosing and seizure monitoring during ECT. 779 11

1. After a series of electroconvulsive seizures, levels of TRH-Gly (the immediate precursor of TRH) in four limbic regions correlate significantly and highly with increased swimming in the forced-swim test model of antidepressant efficacy. Only in hippocampus did TRH itself correlate with swimming. 2. After ECS, limbic forebrain regions differ in the relationship of TRH to its precursor peptides. This probably results from differences in the coordination of induction of TRH-processing enzymes, as well as differences in the level of prepro-TRH following seizures. 3. Sprague-Dawley rats that are partially kindled with corneal stimulation swim less in the forced-swim test, opposite to the effect seen with antidepressant agents. 4. Pyriform cortex is unique among the four limbic regions examined in showing decreased amounts of the TRH precursor following swim/stress. 5. Combining ECS with the forced-swim test of antidepressant effects creates a useful model for studying the involvement of TRH and its precursor peptides in both the antidepressant and anticonvulsant effects of controlled therapeutic seizures in the treatment of major depressive disorders. Regional differences between the effects of pinnate and corneal ECS on peptides and behavior support the idea that corneal ECS is a better model than pinnate ECS for human bitemporal ECT. 6. Together with recent results in other laboratories, our results suggest that a series of generalized seizures results in prolonged and increased release and action of TRH in limbic forebrain.
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PMID:TRH gene products are implicated in the antidepressant mechanisms of seizures. 783 67

The current practice of monitoring brain electrical activity with single channel recordings during ECT induced seizures does not meet contemporary EEG standards. Multichannel recordings are essential for artifact identification, determination of seizure endpoint, and assessment of electrophysiological features in different brain regions. Careful attention to technical aspects and detailed descriptions are important for interpretation and for scientific communication. Standardized procedures for EEG monitoring during ECT should be developed for general clinical use and for research and training applications.
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PMID:EEG monitoring during ECT research. 783 59

Past research focused on characterizing the cognitive deficits caused by ECT, understanding their causes, and defining ways of ameliorating the deficits. Future research includes the following recommendations. IN CHARACTERIZING THE DEFICITS: more accurately defining the time course to recovery; finding out whether specific memory tasks and specific patients show long-lasting effects; and defining specific components of memory and non-memory deficits (e.g., associative memory, incidental everyday memory, inattention). IN UNDERSTANDING THE CAUSES: determining whether seizure activity in certain brain structures is associated with specific cognitive deficits; finding out in which ways electric dose, electrode placement, seizure duration, and seizure threshold interact in causing the deficits; evaluating the effects of mediating variables such as blood pressure rise; and assessing the influence of background variables such as age, sex, and brain abnormality. IN AMELIORATING THE DEFICITS: continuing the search for effective medication; defining ways of reducing the number of treatments (twice weekly ECT, caffeine or thyroxine modified treatment); and manipulating dose in relation to electrode placement.
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PMID:Neuropsychology and ECT: past and future research trends. 787 83

Empirical titration procedures increasingly are being used to estimate initial seizure threshold. These procedures involve the administration of subconvulsive electrical stimulation. There has yet to be evaluation of the impact of such stimulation on the acute cognitive consequences of electroconvulsive therapy. In two studies we randomized depressed patients to right unilateral or bilateral ECT, with stimulus intensity maintained just above seizure threshold throughout the treatment course. These low dosage treatment groups received one or more subconvulsive stimuli in approximately 40% of treatment sessions, with a grand mal seizure also elicited at each session. Extensive neuropsychological evaluation was conducted at each session. We contrasted treatment sessions in which generalized seizures were preceded by subconvulsive stimulation with treatment sessions in which a single convulsive stimulation was applied. Across a variety of neuropsychological measures, there were no adverse cognitive consequences of subconvulsive stimulation.
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PMID:Acute cognitive effects of subconvulsive electrical stimulation. 805 91

While unilateral electroconvulsive therapy (U-ECT) is generally considered to induce negligible disturbances of memory as compared with bilateral bitemporal ECT, its relative antidepressant efficacy has been questioned. The aim of the present study was to compare, in a double-blind design, clinicians' ratings of global clinical impression of the antidepressant efficacy of the two treatment modalities. The treatment technique included avoidance of benzodiazepines, prolonged hyperventilation with oxygen, intermittent unidirectional pulses distributed in a long pulse train, permitting individualized and relatively high doses of electrical charge at each treatment occasion, and non-dominant long-distance (12-13 cm) parietotemporal (d'Elia) electrode placement in the U-ECT group. The results indicated no therapeutic advantage for either treatment modality, which was also in accordance with the symptom ratings by an independent nonblinded rater. The findings encourage the continued use of nondominant long-distance parietotemporal ECT with a treatment technique that induces fully generalized seizures as the modality of choice in the convulsive treatment of depression.
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PMID:The antidepressant efficacy of high-dose nondominant long-distance parietotemporal and bitemporal electroconvulsive therapy. 805 92

Optimizing the safety and the efficacy of a treatment course has been a persistent goal of ECT practice since its introduction sixty years ago. Muscle relaxants, barbiturate anesthesia, and oxygenation were developed to reduce the risks of fracture, fear, and cognitive deficits. Unilateral electrode placement elicited fewer cognitive complaints and was reported as clinically effective as bilateral placement. Seizure duration monitoring, first by cuff and then by EEG, was introduced to define "an effective seizure". Caffeine pre-treatment lengthened seizure durations. Brief pulse square wave currents replaced sinusoidal currents to reduce cognitive effects. Twice weekly treatments were shown to be as effective as three treatments weekly, although the latter was more rapidly effective. Continuation ECT became a feature of practice. The safety and efficacy of psychoactive drugs combined with ECT were clarified so that antipsychotic drugs now are generally continued; benzodiazepines, lithium, and anticonvulsants are withdrawn; and the continuation of antidepressant drugs is optional. In recent studies, the minimal energy needed to elicit a seizure was determined and energy dosing is suggested as 2.5 times [or other multiple] of the threshold. Others find that age or half-age dosing methods are satisfactory and with less risk to patients. The definition of an "effective seizure" as one that is 25 seconds or longer in motor convulsive activity is questioned and EEG criteria are examined as substitutes.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Optimizing ECT. 808 32

Two separate methods of preventing post-ECT emergence agitation are increasing the succinylcholine dose to about 1.1 mg/kg and adding a methohexital bolus of about 0.67 mg/kg immediately at seizure end. These methods can work separately and additively without any expectation of diminishing treatment efficacy. A relevant case is described.
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PMID:ECT emergence agitation and methohexital-succinylcholine interaction. Case report. 830 49


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