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

Electroconvulsive therapy (ECT) is an established effective treatment modality for patients with severe depression. Recent studies have focused on developing predictors of response. In this prospective study, using percent decrease in Hamilton Depression Scale (21 items) as the outcome measure, we blindly evaluated 33 inpatients with major depression to determine whether postictal suppression, the electrical silence following induced seizure, would predict treatment response to ECT. A significant relationship was observed between degree of postictal suppression and likelihood of clinical improvement. Postictal suppression should be explored in more controlled studies as a predictor of ECT response.
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PMID:Is postictal electrical silence a predictor of response to electroconvulsive therapy? 893 5

Seven patients with major depression who developed seizure inhibition during a course of ECT, were given intravenous theophylline to increase seizure duration. Infusion of 100-200 mg of theophylline, administered slowly over several minutes approximately 30 min before seizure induction, was found to effectively and safely prolong seizure durations. In a total of 55 treatment sessions, no cardiovascular or other complications were seen. On one occasion, seizure duration was prolonged to 220 s.
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PMID:Facilitation of ECT by intravenous administration of theophylline. 903 98

Nefazodone hydrochloride is a phenylpiperazine antidepressant with a mechanism of action that is distinct from those of other currently available drugs. It potently and selectively blocks postsynaptic serotonin (5-hydroxytryptamine; 5-HT) 5-HT2A receptors and moderately inhibits serotonin and noradrenaline (norepinephrine) reuptake. In short term clinical trials of 6 or 8 weeks' duration, nefazodone produced clinical improvements that were significantly greater than those with placebo and similar to those achieved with imipramine, and the selective serotonin reuptake inhibitors (SSRIs) fluoxetine, paroxetine and sertraline. The optimum therapeutic dosage of nefazodone appears to be between 300 and 600 mg/day. Limited long term data suggest that nefazodone is effective in preventing relapse of depression in patients treated for up to 1 year. Analyses of pooled clinical trial results indicate that nefazodone and imipramine produces similar and significant improvements on anxiety- and agitation-related rating scales compared with placebo in patients with major depression. Short term tolerability data indicate that nefazodone has a lower incidence of adverse anticholinergic, antihistaminergic and adrenergic effects than imipramine. Compared with SSRIs, nefazodone causes fewer activating symptoms, adverse gastrointestinal effects (nausea, diarrhoea, anorexia) and adverse effects on sexual function, but is associated with more dizziness, dry mouth, constipation, visual disturbances and confusion. Available data also suggest that nefazodone is not associated with abnormal weight gain, seizures, priapism or significant sleep disruption, and appears to be relatively safe in overdosage. Nefazodone inhibits the cytochrome P450 3A4 isoenzyme and thus has the potential to interact with a number of drugs. Further long term and comparative studies will provide a more accurate assessment of the relative place of nefazodone in the management of major depression. Nonetheless, available data suggest that nefazodone is a worthwhile treatment alternative to tricyclic antidepressants and SSRIs in patients with major depression.
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PMID:Nefazodone. A review of its pharmacology and clinical efficacy in the management of major depression. 921 Oct 88

Psychogenic pain, disturbances of gait and stance, sensory symptoms, dizziness, and psychogenic seizures have been found to be the most common conversion symptoms in neurology clinics. A retrospective analysis of 18 patients suffering from pseudoseizure "status" is presented in this study. All of the patients fulfilled the DSM-III-R criteria of conversion disorder. However, 5 of them had concomitant major depression, 6 suffered from bulimia nervosa, and 7 met the criteria for substance abuse. On Axis II, 10 cases of borderline personality disorder, 2 cases of antisocial personality disorder, and 3 cases of histrionic personality disorder were diagnosed. The majority of the patients had attempted suicide and other forms of self-destructive behavior. The findings suggest that patients with pseudoseizure "status" suffer from severe affective imbalances and disturbed impulse control.
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PMID:Pseudoseizure "status". 919 24

Although electroconvulsive therapy (ECT) is believed to have a rapid onset of antidepressant activity, there has been limited investigation in this area. This study contrasted alternative statistical methods for testing treatment group differences in the rapidity of clinical response to ECT. Patients with major depression were randomly assigned to receive right unilateral or bilateral ECT and low or high electrical dosage relative to seizure threshold. The 24-item Hamilton Rating Scale for Depression (HRSD) was administered by blinded clinical raters twice weekly (non-treatment days). We evaluated four alternative statistical strategies. Two methods considered time to improvement as a dependent variable: (a) time (treatment number) to reach various cutoffs for percentage decrease in HRSD from baseline; and (b) survival analysis using the same cutoffs for percentage decreases as endpoints. Two methods considered time to improvement as an independent variable: (c) the slope of linear regression of HRSD scores against treatment number; and (d) a random regression model using the HRSD scores as repeated measures. The statistical methods differed in whether or not omnibus group differences were observed, the criterion level of improvement associated with group differences, and the results of pairwise comparisons establishing specific therapeutic advantages. Survival analysis generally displayed the greatest sensitivity in detecting treatment group differences.
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PMID:Quantifying the speed of symptomatic improvement with electroconvulsive therapy: comparison of alternative statistical methods. 943 65

Electroconvulsive therapy (ECT) utilises the electrical induction of a generalised seizure for treating severe mental disorders. The treatment, developed in 1938, is neglected especially in Germany. This is partly due to the original application in non-anaesthetised patients resulting in many atraumatic side effects. Since the beginning of the sixties, "modified" ECT under anaesthesia with neuromuscular blockade has become worldwide standard. Controlled studies showed that in major depression ECT is at least equal to pharmacotherapy with relatively few adverse side effects. ECT is an effective alternative in patients resistant to pharmacotherapy. The development of modern ECT devices with improved kinds of impulses has reduced the incidence of cognitive side effects in recent years. Due to a variety of centrally acting co-medications and circulatory effects during ECT, these patients are quite a challenge to the anaesthesiologist. Common hypnotic agents obstruct the generation of convulsions. Therefore, therapeutic outcome is directly influenced by the quality of the anaesthetic management. This review is intended to familiarise with the ECT and to provide hints for an optimised selection, setup and practice of anaesthetic treatment.
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PMID:[Electroconvulsive therapy--anesthesiological procedures]. 944 55

1. Structural neuropathologic abnormalities have been associated with severe psychiatric illnesses, including bipolar disorder, major depressive disorder, and schizophrenia. In the latter, ventricular enlargement has been variably associated with symptom severity and poor treatment response. In patients with severe depressive disorders, the relationship between cortical and subcortical pathology and ventricle enlargement, symptom severity, and response to treatment is far from clear. 2. The present study investigated the relationship between structural CNS pathology, symptom severity and treatment response in patients undergoing ECT. It was hypothesized that patients with greater neuroanatomic abnormalities would demonstrate greater initial symptom severity and poorer response to ECT. 3. The subjects were 57 patients with unipolar or bipolar depression admitted for ECT treatment. Symptom severity was quantified using the Hamilton Depression Rating Scale (HRSD) at baseline and post-ECT. 4. Lateral and third ventricle-brain ratio (LVBR, 3VBR) were determined from CT scans and cortical atrophy was rated by a faculty neuroradiologist. 5. Contrary to our first hypothesis, structural pathology was not associated with baseline symptom severity. In terms of treatment response, the number of treatments required to achieve benefit was correlated with larger 3VBR; CT variables were not related to total post-treatment or change in HRSD score. Third ventricle enlargement may be an index of generalized pathology or regional brainstem abnormalities that influence ECT response rate by limiting individual seizure efficacy or neurochemical responsiveness, thereby necessitating a greater number of ECT treatments, without significant impact on overall response.
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PMID:Does neuroanatomy predict ECT response? 946 96

In this first report of electroconvulsive therapy (ECT) for the simultaneous treatment of seizures and depressive episodes, the authors discuss the use of ECT in the treatment of complex-partial seizures and major depression in a geriatric patients who refused antidepressant and antiepileptic medication. ECT has numerous anticonvulsant effects, including elevated seizure threshold and decreased seizure duration, which make it a useful adjunctive therapy in epilepsy that is refractory or not amenable to treatment with medication.
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PMID:Electroconvulsive therapy for epilepsy and major depression. 958 Dec 14

Depression is a significant problem in epilepsy. Suicides occur in epileptic patients five times more often than in general population. Material included 34 epileptics with 76 suicidal attempts and 24 patients with no history of suicide. Psychical state was studied with Beck Depression Inventory and Hamilton Depression Rating Scale. In the group with suicidal attempts 65% of patients had depression (54.5% of them had major depression) and in group without suicide attempts depression was noted in 54% (23% with major depression). Patients with depression were divided into two groups: group I with suicidal attempts and group II without history of suicide. In group I more patients were alcohol abusers (50% vs 31%), more were treated because of epilepsy longer than 10 years (59% vs 46%) and more had tonic-clonic seizures (82% vs 46%). In group I, 54% of patients were on polytherapy (more than half of them with fenobarbital). In group II, 31% of epileptics were on polytherapy (no one with fenobarbital). Major depression was significantly more frequent in epileptics with suicidal attempts. The severity of depression may influence the risk of suicide. Major depression may be associated with late age of onset of epilepsy, longer treatment duration, tonic-clonic seizures, polytherapy (mainly with fenobarbital) and alcohol abuse.
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PMID:[Depression in epileptic patients with and without history of suicidal attempts: preliminary report]. 964 Sep 88

A comprehensive series of clinical trials have compared the unique selective NRI reboxetine with placebo and with the TCAs imipramine and desipramine, as well as with the SSRI fluoxetine. Reboxetine is clearly effective in both the short and the long term compared with placebo. Against comparator antidepressants, reboxetine is at least as effective in the treatment of patients with major depressive disorder in the adult and the elderly population and offers a significant advantage over imipramine in the treatment of melancholic patients. In severely depressed patients, reboxetine was significantly more effective than fluoxetine. Reboxetine also offers significant advantages over fluoxetine in terms of social functioning and has a significantly improved adverse event profile compared with TCAs. In comparison with fluoxetine, reboxetine has a different adverse event profile, but shows advantages in terms of agitation/nervousness/anxiety and gastrointestinal events. Reboxetine is not cardiotoxic, and it is not associated with an increased risk of seizures or of orthostatic hypotension. Overall, reboxetine offers a significant safety advantage over TCAs in the treatment of the depressed population and in subsets of the depressed population in an efficacy comparison with the SSRI fluoxetine.
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PMID:Chairman's overview. The place of reboxetine in antidepressant therapy. 981 28


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