1
|
Wadi L, Mandge V. Electroconvulsive therapy for catatonia in anti-NMDA receptor encephalitis: A case series. J Neuroimmunol 2024; 386:578271. [PMID: 38155066 DOI: 10.1016/j.jneuroim.2023.578271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 12/14/2023] [Accepted: 12/18/2023] [Indexed: 12/30/2023]
Abstract
BACKGROUND Anti-NMDAR encephalitis is the most common cause of immune-mediated catatonia. CASE SERIES Three females presented with neuropsychiatric symptoms and were empirically treated with first-line immunotherapy and ovarian teratoma resection for suspected autoimmune encephalitis, preceding diagnostic confirmation via NMDAR antibody positivity. They required escalating large doses of benzodiazepines for refractory malignant catatonia resulting in ICU level care. ECT treatments were initiated, and patients were gradually noted to have clinical improvement as was measured by the Bush-Francis Catatonia Rating Scale. CONCLUSIONS Clinicians should recognize catatonia among patients with suspected anti-NMDAR encephalitis and consider the early implementation of ECT into treatment algorithms.
Collapse
Affiliation(s)
- Lara Wadi
- Duke University Hospital, 2301 Erwin Road, Durham, NC 27705, United States of America.
| | - Vishal Mandge
- Duke University Hospital, 2301 Erwin Road, Durham, NC 27705, United States of America; Duke Regional Hospital, 3643 N Roxboro St, Durham, NC 27704, United States of America.
| |
Collapse
|
2
|
Wada K, Kurata A, Iwamoto T, Gon J, Shimizu H. Oral theophylline augmentation for patients with missed or inadequate seizures with electroconvulsive therapy. Asian J Psychiatr 2022; 73:103148. [PMID: 35597185 DOI: 10.1016/j.ajp.2022.103148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Accepted: 05/02/2022] [Indexed: 11/02/2022]
Abstract
AIM An inadequate seizure occasionally occurs during a course of acute electroconvulsive therapy (ECT) under the maximum approved electrical stimulation in Japan of 504 mC. This retrospective study was conducted to determine the effectiveness and adverse reactions of an oral theophylline augmentation technique. METHODS A retrospective review of medical records was conducted of patients admitted to the Department of Psychiatry, Hiroshima Citizens Hospital, who received acute phase ECT from October 2014 to March 2017. RESULTS A theophylline augmentation technique was instituted in 13 patients (7 males, 6 females; 56-79 years old). The total number of ECT sessions per patient ranged from 9 to 20 and the number of those with theophylline augmentation per patient ranged from 1 to 17. An augmentation effect was noted in all patients and each finished the scheduled ECT course, except for 1 who developed memory disturbance. The maximum dose of theophylline ranged from 200 to 700 mg/day, and the serum level at 06:00 on the day of the ECT session ranged from 5.3 to 23.6 mg/L in 12 patients, as 1 missed the examination. CONCLUSION Oral theophylline augmentation can be considered as an effective treatment option for patients undergoing ECT with inadequate seizures.
Collapse
Affiliation(s)
- Ken Wada
- Department of Psychiatry, Hiroshima Citizens Hospital, Hiroshima City Hospital Organization, Japan.
| | - Akiko Kurata
- Department of Psychiatry and Neurosciences and Palliative Care Team, Hiroshima University Graduate School of Biomedical Science, Japan
| | | | | | | |
Collapse
|
3
|
Elias A, Thomas N, Sackeim HA. Electroconvulsive Therapy in Mania: A Review of 80 Years of Clinical Experience. Am J Psychiatry 2021; 178:229-239. [PMID: 33167675 DOI: 10.1176/appi.ajp.2020.20030238] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Resistance to pharmacological agents is commonly encountered in the treatment of acute episodes of mania. In contemporary practice guidelines, electroconvulsive therapy (ECT), once a widely used standalone intervention for mania, is no longer considered a first-line treatment. Stigma, logistics, and ethical factors constrain ECT administration in this condition and lead to its underutilization. However, the past three decades have produced promising research regarding the use of ECT in mania. Randomized controlled trials, albeit in limited numbers, the adoption of ultrabrief ECT, examination of the safety and efficacy of combining ECT with pharmacological agents, including lithium, and use of ECT as a maintenance strategy have enhanced our understanding of how and when to utilize this intervention in mania. In this comprehensive review, the authors summarize the evidence regarding the efficacy and safety of ECT in mania, including related syndromes, such as delirious mania and mixed affective states. The impact of technical parameters, particularly the choice of treatment frequency, electrode placements, and pulse width, are discussed in the light of recent evidence.
Collapse
Affiliation(s)
- Alby Elias
- Department of Psychiatry, University of Melbourne, Victoria, Australia (Elias, Thomas); Departments of Psychiatry and Radiology, College of Physicians and Surgeons, Columbia University, New York (Sackeim)
| | - Naveen Thomas
- Department of Psychiatry, University of Melbourne, Victoria, Australia (Elias, Thomas); Departments of Psychiatry and Radiology, College of Physicians and Surgeons, Columbia University, New York (Sackeim)
| | - Harold A Sackeim
- Department of Psychiatry, University of Melbourne, Victoria, Australia (Elias, Thomas); Departments of Psychiatry and Radiology, College of Physicians and Surgeons, Columbia University, New York (Sackeim)
| |
Collapse
|
4
|
McGrane IR, Tenison RE, Bimler DM, Munjal RC, Molinaro JR. Successful bilateral electroconvulsive therapy in a patient with a seizure disorder taking levetiracetam, lorazepam, and zonisamide: A case report. Ment Health Clin 2021; 11:23-26. [PMID: 33505822 PMCID: PMC7800328 DOI: 10.9740/mhc.2021.01.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Electroconvulsive therapy (ECT) may be considered for treatment of severe, treatment-resistant, and emergent depression associated with MDD or bipolar disorder. Patients with epilepsy usually take medications that raise the seizure threshold, which poses challenges during ECT. We report a 66-year-old male with epilepsy taking levetiracetam extended-release (XR), lorazepam, and zonisamide requiring ECT for severe MDD. After literature review, the XR form of levetiracetam was changed to higher doses of the immediate-release (IR) formulation, and zonisamide was discontinued 2 days prior to ECT in the hospital and was resumed when the patient underwent outpatient continuation ECT. The patient was treated to remission after receiving 8 acute bilateral ECT treatments before being transitioned to continuation ECT. We provide a brief review of medication management of antiepileptic drugs and other medications that increase the seizure threshold during ECT. To our knowledge, this is the first reported case describing the management of levetiracetam, lorazepam, and zonisamide concomitantly during ECT. Our case suggests that utilizing the IR formulation of levetiracetam, administering the evening dose early the day prior to the procedure, and temporarily discontinuing zonisamide prior to bilateral ECT is effective for the treatment of severe MDD while maintaining seizure prophylaxis.
Collapse
Affiliation(s)
- Ian R McGrane
- PGY-1 Pharmacy Resident, Providence St Patrick Hospital, Department of Pharmacy, Missoula, Montana.,Student, Skaggs School of Pharmacy, College of Health, The University of Montana, Missoula, Montana.,Psychiatrist, Providence St Patrick Hospital, Department of Psychiatry, Missoula, Montana.,Psychiatrist, Providence St Patrick Hospital, Department of Psychiatry, Missoula, Montana
| | - Rachel E Tenison
- PGY-1 Pharmacy Resident, Providence St Patrick Hospital, Department of Pharmacy, Missoula, Montana
| | - Dana M Bimler
- Student, Skaggs School of Pharmacy, College of Health, The University of Montana, Missoula, Montana
| | - Robert C Munjal
- Psychiatrist, Providence St Patrick Hospital, Department of Psychiatry, Missoula, Montana
| | - Jason R Molinaro
- Psychiatrist, Providence St Patrick Hospital, Department of Psychiatry, Missoula, Montana
| |
Collapse
|
5
|
Janjua AU, Dhingra AL, Greenberg R, McDonald WM. The Efficacy and Safety of Concomitant Psychotropic Medication and Electroconvulsive Therapy (ECT). CNS Drugs 2020; 34:509-520. [PMID: 32342484 DOI: 10.1007/s40263-020-00729-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Electroconvulsive therapy (ECT) is an effective treatment for severe psychiatric disorders. Patients referred to ECT are often taking multiple medications, many of which can potentially affect the safety and efficacy of their course of ECT. This review evaluates the impact of a variety of psychotropic medications often used in conjunction with ECT and examines strategies to optimize their management. The review encompasses mood stabilizers, antidepressants, benzodiazepines, antiepileptics, antipsychotics, and other commonly used psychotropics.
Collapse
Affiliation(s)
- A Umair Janjua
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, 12 Executive Park Drive, NE, Atlanta, GA, 30329, USA.
| | - Amitha L Dhingra
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, 12 Executive Park Drive, NE, Atlanta, GA, 30329, USA
| | | | - William M McDonald
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, 12 Executive Park Drive, NE, Atlanta, GA, 30329, USA
| |
Collapse
|
6
|
[Electroconvulsive therapy in combination with psychotropic and non-psychotropic pharmacological treatments: Review of the literature and practical recommendations]. L'ENCEPHALE 2020; 46:283-292. [PMID: 32151451 DOI: 10.1016/j.encep.2020.01.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Revised: 01/08/2020] [Accepted: 01/10/2020] [Indexed: 11/21/2022]
Abstract
CONTEXT Electro-convulsive therapy (ECT) is the most effective treatment for treatment resistant mood disorders and catatonia. ECT also appears to be an effective treatment in combination with clozapine in the context of treatment resistant schizophrenia spectrum disorders. Although increasingly codified (guidelines on indications, contraindications, methods of implementation), the practice of ECT still lacks consensual protocols. The concomitant use of psychotropic and/or non-psychotropic medication is a common situation when ECT treatment is considered. To our knowledge, there is to date no summary of studies or case reports in France, nor any proposal for guidelines concerning the management of medication of the patient to whom ECT sessions are offered. Indeed, several particularities must be considered. This article proposes to specify for each pharmacological class the possible interaction between ECT and medication. A first section of this article will be devoted to non-psychotropic treatments, and a second section to psychotropic treatments. A practical summary table is also provided. METHOD A review of the literature was conducted including all articles published prior to January 2019 referenced in Pub Med database, combining research with Medical Subject Headings "Electroconvulsive Therapy" and each following pharmacological class: "Cardiovascular Agents" "Bronchodilator Agents" "Bronchoconstrictor Agents" "Theophylline" "Anticoagulants" "Hypoglycemic Agents" "Insulin" "Potassium" "Benzodiazepines" "Valproic Acid" "Carbamazepine" "Lamotrigine" "Lithium" "Antidepressive Agents" "Antipsychotic Agents". RESULTS After reading the titles, abstracts and whole articles, then searching for additional articles in the references, 50 articles were selected. A summary table summarizing the main risks and proposing a course of action has been produced. DISCUSSION It is essential to take into account the specificity and the different physiological mechanisms involved in the ECT treatment in order to adjust the associated pharmacological treatments. The prescription for each molecule should be reviewed when ECT treatment is initiated.
Collapse
|
7
|
Abstract
PURPOSE Whether the antiepileptic agents used by patients before the treatment should be discontinued after the initiation of the electroconvulsive therapy (ECT), which is one of the most effective treatment options in psychiatry, is a dilemma frequently faced by clinicians. Recently, there has been an increased interest in this subject. This study aimed to determine the impact of antiepileptic agents on ECT process in the event of continued use in the course of the therapy. METHODS From among the patients on an ECT therapy in the Psychiatry Clinic of Hacettepe University Hospital since 2010, a total of 39 patients who continued to use the antiepileptic agent they were taking prior to the ECT therapy were determined and included in the study. As for the control group, on the list of ECT patients, the 39 patients coming immediately after the patients using antiepileptics were taken up in the study. The patients using antiepileptics were compared with the control subjects on the basis of their sociodemographic characteristics, number of active sessions, energy levels of the past seizures, seizure durations, some clinical outcomes, and characteristics of the first and the last seizures. RESULTS There were no differences between the control subjects and those using the antiepileptics in terms of average age, body mass index, Clinical Global Impression scores, and sex distribution. Energy levels required to induce the first and the last seizures and total amounts of energy used in active seizures were significantly higher in patients taking the antiepileptics than the control group. Besides, the durations of the first peripheral and central seizures were significantly less in patients using the antiepileptics as compared with the control subjects. When sociodemographic variables and numeric data about the seizures were brought into the equation in the binary logistic regression analysis for determination of being included in either the group of patients taking antiepileptics or the control group, the only meaningful variable was found to be "duration of the first central seizure." CONCLUSIONS Continued use of the antiepileptics during ECT by the patients to undergo ECT may lead to an increased dose of energy to be used during the therapy. When all variables are taken into consideration, it was determined that the use of antiepileptic significantly shortened purely the duration of the first seizure. In the light of the present results, it does not seem meaningful to suggest as a conclusive requirement to discontinue the antiepileptics used before ECT prior to the commencement thereof.
Collapse
|
8
|
Should Benzodiazepines and Anticonvulsants Be Used During Electroconvulsive Therapy?: A Case Study and Literature Review. J ECT 2017; 33:237-242. [PMID: 28767528 DOI: 10.1097/yct.0000000000000441] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVE This study aims to investigate the clinical effects of benzodiazepines or anticonvulsant use during a course of electroconvulsive therapy (ECT). METHOD A case report study of a patient who received ECT with and without concomitant flurazepam and pregabalin is presented. The literature on the use of benzodiazepines and anticonvulsants during ECT is reviewed. RESULTS A woman with treatment resistant depression received a course of ECT while taking flurazepam and pregabalin, but seizures were of short duration and symptomatic improvement was minimal. After discontinuation of flurazepam and pregabalin, a course of right unilateral ultrabrief ECT was associated with adequate seizures and remission of depression and suicidal ideation. Our literature review suggests that benzodiazepines decrease seizure duration, but most evidence shows no association with increased seizure threshold. One prospective RCT and 3 large retrospective studies found that benzodiazepines compromise the efficacy of unilateral but not bilateral ECT. Regarding anticonvulsants, several studies had varied and contradictory results on their effect on seizure duration and seizure threshold. Of the 2 large retrospective studies and 3 RCTs, only 1 retrospective study showed that anticonvulsants decrease the efficacy of ECT. CONCLUSIONS Judicious assessment of all medications used in combination with ECT is recommended. Overall, published studies suggest that benzodiazepines and anticonvulsants impact the clinical outcomes of ECT less than what would be expected given their pharmacologic effects. However, there are significant gaps in the literature, including a lack of study on suprathreshold stimulation of right unilateral ECT and the possibility of a greater effect with higher medication doses.
Collapse
|
9
|
Joo SW, Joo YH, Kim CY, Lee JS. Effects of stimulus parameters on motor seizure duration in electroconvulsive therapy. Neuropsychiatr Dis Treat 2017; 13:1427-1434. [PMID: 28603421 PMCID: PMC5457179 DOI: 10.2147/ndt.s134503] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE This study examined the effect of stimulus parameters on the occurrence of adequate seizures and reconsidered the factors related to motor seizure duration. METHODS The medical records of 187 patients who received ECT in Asan Medical Center from January 2007 to May 2014 were retrospectively reviewed. The starting stimulus dose was determined using a preselected-dose method and the cutoff value to determine the adequate motor seizure duration was 20-25 seconds. The association between seizure parameters and the occurrence of adequate seizure was assessed with logistic regression using a generalized estimating equation. RESULTS Age (P<0.001), use of mood stabilizers (P=0.002), and benzodiazepine (P<0.001) were significantly lower in sessions with an adequate seizure duration but use of antidepressants (P<0.001) and clozapine (P=0.025) were significantly higher in sessions with an adequate seizure duration. In the generalized estimating equation analyses, after adjustment for age, benzodiazepine dose, and lamotrigine use, charge (odds ratio [OR] =0.999; 95% confidence interval [CI], 0.998-1.000; P=0.005), and train duration (OR =0.632; 95% CI, 0.490-0.817; P<0.001) were significantly associated with the occurrence of adequate seizure. DISCUSSION Stimulus charge and train duration are significantly associated with motor seizure duration. However, train duration appears to have a greater effect on motor seizure duration. Additionally, age, benzodiazepine dose, and lamotrigine use independently affect motor seizure duration.
Collapse
Affiliation(s)
- Sung Woo Joo
- Department of Psychiatry, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Yeon Ho Joo
- Department of Psychiatry, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Chang Yoon Kim
- Department of Psychiatry, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Jung Sun Lee
- Department of Psychiatry, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| |
Collapse
|
10
|
Haghighi M, Bajoghli H, Bigdelou G, Jahangard L, Holsboer-Trachsler E, Brand S. Assessment of cognitive impairments and seizure characteristics in electroconvulsive therapy with and without sodium valproate in manic patients. Neuropsychobiology 2013; 67:14-24. [PMID: 23221898 DOI: 10.1159/000343490] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2012] [Accepted: 09/10/2012] [Indexed: 11/19/2022]
Abstract
OBJECTIVES The aim of the present study was two-fold: (1) to compare, in a controlled double-blind quasi-randomized clinical trial, treatment improvements, treatment outcome, and cognitive impairments in patients suffering from current manic episodes, while treated with electroconvulsive therapy (ECT) with and without concurrent sodium valproate therapy, and (2) to compare ECT seizure characteristics in patients with and without concurrent sodium valproate therapy. METHODS A total of 40 inpatients (mean age = 31.80 years, SD = 8.06; 75% males) suffering from bipolar disorders and currently in a manic state took part in the study. They were quasi-randomly assigned either to the target (continuation of sodium valproate administration) or to the control group (discontinuation of sodium valproate administration). All patients underwent bifrontal ECT for at least 6 sessions. Improvements and cognitive impairments were assessed, and seizure characteristics (duration, threshold) were also recorded. RESULTS Manic episodes improved significantly over time, and irrespective of the group (target vs. control group). Cognitive impairments did not alter over time or between groups. Seizure duration did not change over time or between groups. Seizure threshold did not change over time, but was lower in the target than in the control group. CONCLUSIONS Continuing the administration of sodium valproate neither adversely affects, nor enhances cognitive impairments or seizure duration, but reduces seizure threshold during ECT in patients suffering from manic episodes. Moreover, gender appeared to be more strongly associated with cognitive impairment and seizure activity than treatment approaches in these psychiatric conditions.
Collapse
Affiliation(s)
- Mohammad Haghighi
- Research Center for Behavioral Disorders and Substance Abuse, Hamadan University of Medical Sciences, Hamadan, Iran
| | | | | | | | | | | |
Collapse
|
11
|
Thirthalli J, Prasad MK, Gangadhar BN. Electroconvulsive therapy (ECT) in bipolar disorder: A narrative review of literature. Asian J Psychiatr 2012; 5:11-7. [PMID: 26878941 DOI: 10.1016/j.ajp.2011.12.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2010] [Revised: 11/04/2011] [Accepted: 12/12/2011] [Indexed: 10/14/2022]
Abstract
In many countries including India electroconvulsive therapy (ECT) is frequently used to treat different phases of bipolar disorder. The response to ECT is impressive in mania, depression and in mixed affective states. Preliminary evidence also suggests benefit from maintenance ECT in bipolar disorder. However, most of the literature on efficacy and adverse effects comes from case series, retrospective reports and open trials - controlled trials have been few and far between. Official guidelines recommend the use of ECT only when there is a dire emergency or when all other options have been exhausted. Concurrent use of lithium and antiepileptic drugs along with ECT is common in clinical practice. While such practice appears to be largely safe, one should be mindful about dose of lithium and possible interference of antiepileptic drugs with efficacy of ECT. The use of suprathreshold bilateral ECT and bifrontal placement of electrodes may confer some advantage over other methods.
Collapse
Affiliation(s)
- Jagadisha Thirthalli
- Department of Psychiatry, National Institute of Mental Health & Neurosciences, Bangalore 560029, India
| | | | | |
Collapse
|
12
|
Abstract
OBJECTIVE : To evaluate the effect of lamotrigine (LMT) on electroconvulsive therapy (ECT)-induced seizures. METHODS : Charts of all patients receiving LMT while undergoing an ECT course from July 2001 through May 2009 were reviewed. Apart from demographic variables, data collection consisted of diagnosis, indication for ECT, index or continuation ECT, electrode placement, stimulus dose, motor and electroencephalographic seizure duration, LMT dose, and number of restimulations. The stimulus dose and the seizure duration of ECT treatments with concurrent LMT (≥200 mg/d) were compared with the stimulus dose and seizure duration of ECT treatments without concurrent LMT. RESULTS : Lamotrigine was used by 19 patients (16 women, 3 men) during 289 treatment sessions. Eleven patients had ECT treatments with and without LMT, of which 8 were at a dosage of 200 mg/d or higher. Analyses did not reveal a significant difference in seizure duration and stimulus dose. Missed seizures, however, occurred more frequently during ECT treatments with concurrent LMT. CONCLUSIONS : In all patients, seizures of adequate duration could be elicited. The combination was well tolerated. Therapeutic doses of LMT do not seem to have a clinically significant influence on the length of ECT-induced seizures nor on the stimulus dose.
Collapse
|
13
|
Virupaksha HS, Shashidhara B, Thirthalli J, Kumar CN, Gangadhar BN. Comparison of electroconvulsive therapy (ECT) with or without anti-epileptic drugs in bipolar disorder. J Affect Disord 2010; 127:66-70. [PMID: 20557948 DOI: 10.1016/j.jad.2010.05.008] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2009] [Revised: 04/28/2010] [Accepted: 05/08/2010] [Indexed: 10/19/2022]
Abstract
BACKGROUND Guidelines regarding the combination of anti-epileptic drugs (AEDs) and ECT have been contradictory. Evidence based knowledge about the advantages and disadvantages of this combination is sparse. METHOD We studied the records of consecutive non-epileptic bipolar disorder patients referred for ECT between the months of January 2006 and January 2008 in an academic psychiatric hospital. Seizure threshold, failure to achieve adequate seizures, maximum electrical charge received and the number of ECTs administered were compared between those who were on AEDs during ECT (AED patients; n=79) and those who were not on AEDs (NAED patients; n=122). Two raters who achieved good inter-rater reliability assessed the clinical outcome from the records using the Clinical Global Impression (CGI) scale. RESULTS AED patients had significantly greater proportion of males, longer duration of episode and treatment and higher co morbidity. AED patients had significantly higher seizure threshold, higher incidence of failure to obtain seizures and shorter duration of motor seizures. Both groups achieved comparable symptomatic improvement at the end of the ECT course [Mean (SD) CGI-I=2.0 (0.4) and 1.96 (0.3) in AED and NAED patients respectively; t=1.4; p=0.15]. However, AED patients had received significantly higher number of ECT sessions [mean (SD)=7.9 (3.0)] than NAED patients [mean (SD)=6.3 (2.1); t=4.3; p<0.01] and stayed for significantly longer time (days) in the hospital [Mean (SD) 25.1 (16.1) and 20.6 (10.5) in AED and NAED patients respectively; t=2.4; p=0.02]. The difference in the outcome remained significant even after controlling for the effects of duration of illness, gender, drug treatment and presence of co morbidity. CONCLUSIONS Symptomatic improvement of patients who are on AEDS during ECT is comparable to those who are not. However, AED patients required a significantly higher number of ECT sessions to achieve this. Prospective studies are required to confirm these findings and also to compare cognitive adverse effects.
Collapse
Affiliation(s)
- Harve Shanmugam Virupaksha
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India
| | | | | | | | | |
Collapse
|
14
|
Rubner P, Koppi S, Conca A. Frequency of and rationales for the combined use of electroconvulsive therapy and antiepileptic drugs in Austria and the literature. World J Biol Psychiatry 2010; 10:836-45. [PMID: 19995220 DOI: 10.1080/15622970902838242] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Our aim was to observe the frequency of combination therapy using antiepileptic drugs (AEDs) and electroconvulsive therapy (ECT) in Austria and the literature, and to provide rationales and recommendations based on clinical and molecular properties. The responsible ECT leaders of eight Austrian departments were contacted for information about combination therapy. A computerized PubMed database search was performed and supplemented by cross-referencing from papers, review articles and psychiatric manuals. The frequency of combination therapy in Austrian departments ranges between 0 and 85.7%. In 17 studies enrolling a total of 189 patients, 87 (46.0%) patients received combination therapy. Of these 87 patients, nine (10.3%) reported adverse effects. ECT and AEDs show overlapping clinical and molecular properties. Combination therapy is an observed reality and, according to the currently available literature, feasible. A comparison of clinical and molecular properties indicates possible augmentative effects, making combination therapy a promising alternative in treatment-resistant cases. But there is still a clear need for prospective case controlled data concerning side effects, safety profiles and effectiveness until it can be recommended.
Collapse
Affiliation(s)
- Paul Rubner
- Department of Neurology, Regional Hospital of Rankweil 1, Rankweil, Austria.
| | | | | |
Collapse
|
15
|
Abstract
Postpartum affective disorders continue to be a major health issue for women. There is a general belief that electroconvulsive therapy (ECT) is effective in treating severe or treatment-refractory postpartum affective illnesses, but evidence to support this assertion is lacking. In this case series, we present 5 cases of women with postpartum depression and psychosis, all of whom had failed prior pharmacological therapy. All 5 women had a significant response within 3 to 6 treatments with ECT. Our findings suggest that ECT is overall an effective treatment of postpartum illnesses. In addition to being an excellent choice for women who have failed prior medication trials, ECT may also be considered for women whose severity of illness necessitates rapid symptom resolution.
Collapse
Affiliation(s)
- Ariadna Forray
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA.
| | | |
Collapse
|
16
|
Abstract
OBJECTIVES To review the literature on the concurrent use of electroconvulsive therapy (ECT) and anticonvulsant drugs (AC) and to provide recommendations to guide clinical practice. METHODS A MEDLINE search (1985-2006) was performed, using the terms "electroconvulsive therapy," "anticonvulsants," "epilepsy," "carbamazepine," "gabapentin," "lamotrigine," "topiramate," and "valproate," supplemented by manual searches of guidelines and textbooks on ECT. RESULTS To date, no prospective, randomized and controlled trials examining outcome and safety of the AC-ECT combination have been published. Existing data are from case reports on the use of ECT for psychiatric conditions that are simultaneously treated with AC, and from case reports of patients treated with ECT and AC for epilepsy or for psychiatric conditions with comorbid epilepsy. Apart from an occasional difficulty in eliciting seizures, no severe adverse effects or complications are reported. CONCLUSIONS The literature that is currently available indicates that ECT can be safely and effectively administered to patients treated with various AC. There is, however, no evidence to combine the 2 treatment modalities to augment therapeutic efficacy.
Collapse
Affiliation(s)
- Pascal Sienaert
- Electroconvulsive Therapy Department and Department of Mood Disorders, University Psychiatric Center-Katholieke Universiteit Leuven, Campus Kortenberg, Leuvensesteenweg, Kortenberg, Belgium.
| | | |
Collapse
|
17
|
|