Therapeutic Uses of Seizures in Neuropsychiatry

Challenges and pitfalls in anesthesia for electroconvulsive therapy

Electroconvulsive therapy (ECT) refers to the application of electricity to the patients' scalp to treat psychiatric disorders, most notably, treatment-resistant depression. It is a safe, effective, and evidence-based therapy that is performed with general anesthesia. Muscle relaxation is used to prevent injuries related to the tonic-clonic seizure caused by ECT. Hypnotics are administered to induce amnesia and unconsciousness, so that, patients do not experience the period of muscle relaxation, while the generalized seizure is left unnoticed. For the anesthesiologist, ECT is associated with the challenges and pitfalls that are related to informed consent, social acceptance of ECT, airway management (especially in COVID-19 patients), and the interaction between ventilation and anesthetics from one viewpoint, and seizure induction and maintenance from another. The exact mode of action of the therapy is as unknown as the optimal choice or combination of anesthetics used.

The Clinical Effect of Electroconvulsive Therapy and Its Relationship with Serum Levels of MMP-9 and CXCL12 in Patients with Mania

INTRODUCTION

Electroconvulsive therapy (ECT) is a non-pharmacological method for the treatment of psychiatric disorders. The precise biochemical mechanism of the effects of ECT is not clear, and since the two factors including matrix metalloproteinase-9 (MMP-9) and stromal cell-derived factor-1 alpha (CXCL12) play an important role in improving nerve damage, the effects of ECT and its relation with serum levels of MMP-9 and CXCL12 in patients with mania were investigated in this study.

METHODS

In this before and after intervention study, the patients with mania, referring to the Qods Hospital in Sanandaj, were selected by the census method during the years 2015-2018. Young's test was performed 24 hrs before and after the first, third, and sixth sessions of ECT. For biochemical analysis, 3 mL of peripheral blood were taken prior to any anesthesia and 6 hrs after the first, third, and sixth sessions. Data were analyzed by two-way ANOVA and Pearson correlation coefficient by using the SPSS16 software.

RESULTS

The results showed a significant decrease in Young's test scores during the first to the sixth session of ECT (P≤0.05). Although the levels of CXCL12 were slightly increased after the sixth course of ECT, they were not significant. Moreover, there were no significant relationship between the Young's test score and the serum levels of both MMP-9 and CXCL12 (P≥0.05).

CONCLUSION

ECT improved patients clinically, but this effect was independent of serum levels of MMP-9 and CXCL12, and possibly other biochemical factors are involved in this pathway.

Electroconvulsive Therapy for Patients with Catatonia: Current Perspectives

Catatonia is a serious, common syndrome of motoric and behavioral dysfunction, which carries high morbidity and mortality. Electroconvulsive therapy (ECT) is the definitive treatment for catatonia, but access to ECT for the treatment of catatonia remains inappropriately limited. Catatonia is observable, detectable, and relevant to various medical specialties, but underdiagnosis impedes the delivery of appropriate treatment and heightens risk of serious complications including iatrogenesis. Current understanding of catatonia's pathophysiology links it to the current understanding of ECT's mechanism of action. Definitive catatonia care requires recognition of the syndrome, workup to identify and treat the underlying cause, and effective management including appropriate referral for ECT. Even when all of these conditions are met, and despite well-established data on the safety and efficacy of ECT, stigma surrounding ECT and legal restrictions for its use in catatonia are additional critical barriers. Addressing the underdiagnosis of catatonia and barriers to its treatment with ECT is vital to improving outcomes for patients. While no standardized protocols for treatment of catatonia with ECT exist, a large body of research guides evidence-based care and reveals where additional research is warranted. The authors conducted a review of the literature on ECT as a treatment for catatonia. Based on the review, the authors offer strategies and future directions for improving access to ECT for patients with catatonia, and propose an algorithm for the treatment of catatonia with ECT.