Use of ultrabrief pulse width electroconvulsive therapy to induce therapeutic seizures in an elderly patient with a high seizure threshold: a case report

2019 ◽  
Vol 28 (3) ◽  
pp. 291-296
Author(s):  
David Plevin ◽  
Susan Waite
Keyword(s):  
Case Report ◽  
Electroconvulsive Therapy ◽  
Pulse Width ◽  
Depressive Illness ◽  
Electrode Placement ◽  
Seizure Threshold ◽  
Augmentation Strategies ◽  
Seizure Quality ◽  
Unipolar Major Depression

Objective: This case report describes a 73-year-old man suffering from unipolar major depression with melancholic features, in whom treatment with electroconvulsive therapy (ECT) proved difficult due to inadequate seizure generation. Methods: A number of augmentation strategies were trialled in an attempt to improve seizure quality. Pre-ECT and Post-ECT measurement of symptoms, quality of life and cognition were undertaken with a variety of validated scales. Results: The single most efficacious strategy to elicit therapeutic seizures was the use of right unilateral (RUL) electrode placement with an ultrabrief pulse width. The patient subsequently had a resolution of his depressive illness, with a concomitant improvement in cognitive functioning. Conclusion: This case demonstrates that a number of ECT augmentation strategies can be used in routine clinical practice for patients with high seizure thresholds. It highlights that UB pulse width may be considered earlier in the treatment course for patients in whom conventional brief pulse ECT fails to generate effective seizures.

scholarly journals Alfentanil anesthetic augmentation lengthens seizure duration in electroconvulsive therapy with older people

2016 ◽  
Vol 28 (6) ◽  
pp. 1051-1052
Author(s):  
Craig D'Cunha ◽  
Christos Plakiotis ◽  
Daniel W. O'Connor
Keyword(s):  
Side Effects ◽  
Older People ◽  
Electroconvulsive Therapy ◽  
Electrode Placement ◽  
Seizure Threshold ◽  
Dose Titration ◽  
Seizure Duration ◽  
New Learning ◽  
Prescription Rates ◽  
Cognitive Side Effects

Electroconvulsive therapy (ECT) prescription rates rise with age, making it important that treatments be made as effective and safe as possible (Plakiotis et al., 2012). Older people are vulnerable to post-treatment confusion and to subsequent deficits in attention, new learning, and autobiographical memory (Gardner and O'Connor, 2008). Strategies to minimize cognitive side-effects include unilateral electrode placement and stimulus dose titration whereby electrical charge is individually calibrated to seizure threshold (Sackeim et al., 2000). It remains the case, however, that threshold levels typically rise over the treatment course, leading to an increase both in delivered charge and the risk of adverse sequelae.

Which Depressed Patients will Respond to Electroconvulsive Therapy?

1989 ◽  
Vol 154 (1) ◽  
pp. 8-17 ◽  
Author(s):  
Allan I. F. Scott
Keyword(s):  
Effective Treatment ◽  
Clinical Features ◽  
Electroconvulsive Therapy ◽  
Physiological Responses ◽  
Depressive Illness ◽  
Seizure Threshold ◽  
Posterior Pituitary ◽  
Clinical Predictors ◽  
Depressed Patients ◽  
Wide Range

A small yet significant minority of contemporary patients with endogenous depressive illness who are treated with electroconvulsive therapy (ECT) gain little or no benefit. It is argued that the use of clinical features alone may not improve the ability to predict outcome after ECT. Many biological measures have been used to attempt to identify depressed patients for whom ECT would be an effective treatment, but none has yet been shown to be superior to clinical predictors. Depressed patients show a wide range of physiological responses to the first treatment of a course of ECT. Of these physiological responses, estimations of seizure threshold and of the release of posterior pituitary peptides merit further investigation as putative predictors of recovery.

Changing Patterns of Electroconvulsive Therapy Use: Results of a Five-Year Survey

1991 ◽  
Vol 25 (4) ◽  
pp. 535-540 ◽  
Author(s):  
Cherrie A. Galletly ◽  
Colin D. Field ◽  
Cheryl L. Ormond
Keyword(s):  
Informed Consent ◽  
Electroconvulsive Therapy ◽  
Electrode Placement ◽  
Seizure Threshold ◽  
Efficacy And Safety ◽  
Gradual Decline ◽  
Proven Efficacy ◽  
Schizophrenic Patients ◽  
Changing Patterns ◽  
Medicolegal Issues

Despite its proven efficacy and safety, electroconvulsive therapy (ECT) continues to be a controversial treatment. Ongoing scrutiny is therefore particularly important. We reviewed 315 patients who received 3903 ECT treatments over a five year period, and found a gradual decline in the use of ECT, due mainly to a reduction in ECT for schizophrenic patients. Eighty percent of treatments were given with bilateral electrode placement, although we did find the incidence of adverse effects to be greater with bilateral ECT. Most patients concurrently received medications which raise the seizure threshold. The administration of ECT to patients unable or unwilling to give informed consent raises ethical and medicolegal issues. We found that such difficulties had arisen with at least 16% of patients.

The Role of Electroconvulsive Therapy in the Treatment of Depressive Illness in Old Age

1989 ◽  
Vol 155 (2) ◽  
pp. 147-152 ◽  
Author(s):  
Susan M. Benbow
Keyword(s):  
Old Age ◽  
Electroconvulsive Therapy ◽  
Age Groups ◽  
The Elderly ◽  
Depressive Illness ◽  
Electrode Placement ◽  
Physical Problems ◽  
Younger Age ◽  
Old Age Psychiatry ◽  
Temporary Memory

Electroconvulsive therapy is an important treatment in the depressive states of late life, and there is general agreement about the indications for its use in old age psychiatry. Indeed, old age may be associated with a better response to ECT than that in younger age groups. The additional risk involved through physical problems in the elderly is not great when compared with that of continuing depression and of the side-effects of alternative treatments. Temporary memory disorders and confusion may occur, but are minimised if unilateral electrode placement is used. Some patients treated with unilateral ECT do not respond, but will respond to bilateral treatment. Anxiety over unwanted treatment effects, which can lead to ineffective treatment of depressive illness, must be outweighed by knowledge of the dangers of leaving depression untreated in old age.

scholarly journals Serial case report of high seizure threshold patients that responded to the lengthening of pulse width in ECT

2021 ◽  
Author(s):  
Hiroshi Katagai ◽  
Norio Yasui‐Furukori ◽  
Hirotsugu Kawashima ◽  
Taro Suwa ◽  
Chieko Tsushima ◽  
...  
Keyword(s):  
Case Report ◽  
Pulse Width ◽  
Seizure Threshold

Continuation Electroconvulsive Therapy: Preliminary Guidelines and an Illustrative Case Report

1991 ◽  
Vol 159 (6) ◽  
pp. 867-870 ◽  
Author(s):  
Allan I. F. Scott ◽  
David J. Weeks ◽  
Claire F. Mcdonald
Keyword(s):  
Case Report ◽  
Electroconvulsive Therapy ◽  
Depressive Illness ◽  
Illustrative Case ◽  
Research Findings ◽  
Potential Benefits ◽  
Continuation Treatment ◽  
Meaningful Research

Despite renewed interest in ECT as a continuation treatment after an episode of depressive illness, few guidelines for its use are available. Meaningful research findings are few, although the potential benefits and risks of modern continuation ECT merit study. We suggest preliminary guidelines and provide an illustrative clinical example.

Lowering the seizure threshold in electroconvulsive therapy using transcranial magnetic stimulation: A case report

2019 ◽  
Vol 12 (3) ◽  
pp. 781-784 ◽  
Author(s):  
J. Albrecht ◽  
J. Buday ◽  
T. Mareš ◽  
L. Kališová ◽  
J. Raboch ◽  
...  
Keyword(s):  
Case Report ◽  
Transcranial Magnetic Stimulation ◽  
Electroconvulsive Therapy ◽  
Magnetic Stimulation ◽  
Seizure Threshold

Bitemporal v. high-dose right unilateral electroconvulsive therapy for depression: a systematic review and meta-analysis of randomized controlled trials

2016 ◽  
Vol 47 (3) ◽  
pp. 518-530 ◽  
Author(s):  
E. Kolshus ◽  
A. Jelovac ◽  
D. M. McLoughlin
Keyword(s):  
Side Effects ◽  
Electroconvulsive Therapy ◽  
Verbal Memory ◽  
Randomized Trials ◽  
Electrode Placement ◽  
Seizure Threshold ◽  
Cochrane Library ◽  
High Dose ◽  
Moderate Dose ◽  
Cognitive Side Effects

BackgroundBrief-pulse electroconvulsive therapy (ECT) is the most acutely effective treatment for severe depression though concerns persist about cognitive side-effects. While bitemporal electrode placement is the most commonly used form worldwide, right unilateral ECT causes less cognitive side-effects though historically it has been deemed less effective. Several randomized trials have now compared high-dose (>5× seizure threshold) unilateral ECT with moderate-dose (1.0–2.5× seizure threshold) bitemporal ECT to investigate if it is as effective as bitemporal ECT but still has less cognitive side-effects. We aimed to systematically review these trials and meta-analyse clinical and cognitive outcomes where appropriate.MethodWe searched PubMed, PsycINFO, Web of Science, Cochrane Library and EMBASE for randomized trials comparing these forms of ECT using the terms ‘electroconvulsive’ OR ‘electroshock’ AND ‘trial’.ResultsSeven trials (n = 792) met inclusion criteria. Bitemporal ECT did not differ from high-dose unilateral ECT on depression rating change scores [Hedges's g = −0.03, 95% confidence interval (CI) −0.17 to 0.11], remission (RR 1.06, 95% CI 0.93–1.20), or relapse at 12 months (RR 1.42, 95% CI 0.90–2.23). There was an advantage for unilateral ECT on reorientation time after individual ECT sessions (mean difference in minutes = −8.28, 95% CI −12.86 to −3.70) and retrograde autobiographical memory (Hedges's g = −0.46, 95% CI −0.87 to −0.04) after completing an ECT course. There were no differences for general cognition, category fluency and delayed visual and verbal memory.ConclusionsHigh-dose unilateral ECT does not differ from moderate-dose bitemporal ECT in antidepressant efficacy but has some cognitive advantages.

Fitting the Treatment to the Patient: Recent Advances in the Practice of Electroconvulsive Therapy

1995 ◽  
Vol 29 (3) ◽  
pp. 484-491 ◽  
Author(s):  
Andrew Frukacz ◽  
Philip Mitchell
Keyword(s):  
Cognitive Impairment ◽  
Electroconvulsive Therapy ◽  
Electrode Placement ◽  
Seizure Threshold ◽  
Important Research ◽  
Recent Advances ◽  
Grand Mal ◽  
Necessary And Sufficient ◽  
Practical Recommendations

Traditionally it has been thought that a grand mal seizure is both necessary and sufficient for the maximum efficacy of ECT. Recent important research, however, has demonstrated that both the electrical dosage above the seizure threshold, i.e. the suprathreshold dosage, and the electrode placement (unilateral or bilateral) determine the efficacy of this treatment, as well as the degree of cognitive impairment. This article reviews the development of these significant concepts and suggests specific practical recommendations for incorporating these into contemporary ECT practice.

Do patients who receive electroconvulsive therapy in Scotland get better?

2003 ◽  
Vol 27 (4) ◽  
pp. 137-140 ◽  
Author(s):  
Grace Fergusson ◽  
James Hendry ◽  
Chris Freeman
Keyword(s):  
Electroconvulsive Therapy ◽  
Clinical Setting ◽  
Rating Scale ◽  
National Level ◽  
Depressive Illness ◽  
Electronic Data Collection ◽  
Process And Outcome ◽  
Routine Clinical Setting ◽  
The Uk

Aims and MethodWe aimed to compare the practice of electroconvulsive therapy (ECT) in Scotland with the recommendations of the Royal College of Psychiatrists, to determine the characteristics of patients who receive ECT, to assess the outcome of ECT given in a routine clinical setting and to develop a system of quality assurance for ECT. Between February 1997 and March 2000, an audit of ECT measured the quality of treatment given at all clinics in Scotland. Audit tools were designed and standards set for the process, and outcome of treatment and interventions were identified to address any variance prior to each audit cycle. An electronic data collection system was developed and a website produced for the purpose of continued audit and information sharing.ResultsThe annual rate of ECT in Scotland was 142 individual treatments per 100 000 of the total population. Electroconvulsive therapy was given mainly to White adult patients with a depressive illness who had consented to treatment. Clinical improvement, as measured by at least a 50% reduction in the Montgomery–Åsberg Rating Scale for Depression (MADRS) score, was evident in 71.2% of patients with a depressive episode.Clinical ImplicationsThe audit of ECT is achievable at a national level, ECT is effective in a routine clinical setting and the standards at ECT in Scotland are higher than the UK average.

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