scholarly journals The Neurobiological Basis of Cognitive Side Effects of Electroconvulsive Therapy: A Systematic Review

2021 ◽  
Vol 11 (10) ◽  
pp. 1273
Author(s):  
Adriana Bassa ◽  
Teresa Sagués ◽  
Daniel Porta-Casteràs ◽  
Pilar Serra ◽  
Erika Martínez-Amorós ◽  
...  
Keyword(s):  
Systematic Review ◽  
Side Effects ◽  
Electroconvulsive Therapy ◽  
Cell Damage ◽  
Neuron Specific Enolase ◽  
Predictive Biomarkers ◽  
Current Evidence ◽  
Functional Changes ◽  
Concentration Changes ◽  
Cognitive Side Effects

Decades of research have consistently demonstrated the efficacy of electroconvulsive therapy (ECT) for the treatment of major depressive disorder (MDD), but its clinical use remains somewhat restricted because of its cognitive side effects. The aim of this systematic review is to comprehensively summarize current evidence assessing potential biomarkers of ECT-related cognitive side effects. Based on our systematic search of human studies indexed in PubMed, Scopus, and Web of Knowledge, a total of 29 studies evaluating patients with MDD undergoing ECT were reviewed. Molecular biomarkers studies did not consistently identify concentration changes in plasma S-100 protein, neuron-specific enolase (NSE), or Aβ peptides significantly associated with cognitive performance after ECT. Importantly, these findings suggest that ECT-related cognitive side effects cannot be explained by mechanisms of neural cell damage. Notwithstanding, S-100b protein and Aβ40 peptide concentrations, as well as brain-derived neurotrophic factor (BDNF) polymorphisms, have been suggested as potential predictive biomarkers of cognitive dysfunction after ECT. In addition, recent advances in brain imaging have allowed us to identify ECT-induced volumetric and functional changes in several brain structures closely related to memory performance such as the hippocampus. We provide a preliminary framework to further evaluate neurobiological cognitive vulnerability profiles of patients with MDD treated with ECT.

Electroconvulsive therapy: Brief versus ultrabrief pulse right unilateral electroconvulsive therapy

2016 ◽  
Vol 33 (S1) ◽  
pp. S618-S618
Author(s):  
M.R. Raposo ◽  
M.L. Medina ◽  
A.L. González ◽  
I. Martínez ◽  
A. Gil ◽  
...  
Keyword(s):  
Side Effects ◽  
Electroconvulsive Therapy ◽  
Meta Analysis ◽  
Electrode Placement ◽  
Current Evidence ◽  
List Type ◽  
Treatment Of Depression ◽  
The Subject ◽  
Competing Interest ◽  
Cognitive Side Effects

IntroductionElectroconvulsive therapy (ECT) is an effective depression treatment, but it has potential cognitive side effects. Bitemporal ECT has been traditionally used, but in recent decades, right unilateral (RUL) electrode placement has been proposed to decrease the cognitive side effects of ECT. Ultrabrief pulse (UBP) right unilateral (RUL) ECT is an increasingly used treatment option that can potentially combine efficacy with lesser cognitive side effects.ObjectivesTo evaluate whether ultrabrief pulse (UBP) right unilateral (RUL) electroconvulsive therapy (ECT) is as effective as brief pulse (BP) RUL ECT in addition to cause lesser cognitive side effects.Material and methodsA search is performed in the available scientific literature on systematic review and meta-analysis of the subject under study, through the database PubMed.Results– Current evidence supports the efficacy of right unilateral (RUL) electroconvulsive therapy (ECT) given with an ultrabrief pulse width in the treatment of depression;– ultrabrief pulse RUL ECT leads to lesser cognitive side effects than traditional forms of ECT;– ultrabrief pulse RUL ECT may be slightly less effective than traditional forms of ECT.ConclusionsBP compared with UBP RUL ECT was slightly more efficacious in treating depression and required fewer treatment sessions, but led to greater cognitive side effects. The decision of whether to use BP or UBP RUL ECT should be made on an individual patient basis and should be based on a careful weighing of the relative priorities of efficacy versus minimization of cognitive impairment.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Acetylcholinesterase inhibitors for electroconvulsive therapy-induced cognitive side effects: a systematic review

2017 ◽  
Vol 32 (5) ◽  
pp. 522-531 ◽  
Author(s):  
Marieke J. Henstra ◽  
Elise P. Jansma ◽  
Nathalie van der Velde ◽  
Eleonora L. Swart ◽  
Max L. Stek ◽  
...  
Keyword(s):  
Systematic Review ◽  
Side Effects ◽  
Electroconvulsive Therapy ◽  
Acetylcholinesterase Inhibitors ◽  
Cognitive Side Effects

Anaesthesia for electroconvulsive therapy – new tricks for old drugs: a systematic review

2017 ◽  
Vol 30 (2) ◽  
pp. 61-69 ◽  
Author(s):  
Tobias Kvist Stripp ◽  
Martin Balslev Jorgensen ◽  
Niels Vidiendal Olsen
Keyword(s):  
Systematic Review ◽  
Side Effects ◽  
Electroconvulsive Therapy ◽  
Bispectral Index ◽  
Prospective Studies ◽  
Human Subjects ◽  
Seizure Quality ◽  
Antidepressant Efficacy ◽  
Old Drugs ◽  
Cognitive Side Effects

ObjectiveThe objective of this review is to investigate existing literature in order to delineate whether the use of anaesthesia and timing of seizure induction in a new and optimised way may improve the efficacy of electroconvulsive therapy (ECT).MethodsPubMed/MEDLINE was searched for existing literature, last search on 24 June 2015. Relevant clinical studies on human subjects involving choice of anaesthetic, ventilation and bispectral index (BIS) monitoring in the ECT setting were considered. The references of relevant studies were likewise considered.ResultsPropofol yields the shortest seizures, etomidate and ketamine the longest. Etomidate and ketamine+propofol 1 : 1 seems to yield the seizures with best quality. Seizure quality is improved when induction of ECT is delayed until the effect of the anaesthetic has waned – possibly monitored with BIS values. Manual hyperventilation with 100% O2 may increase the pO2/pCO2-ratio, which may be correlated with better seizure quality.ConclusionEtomidate or a 1 : 1 ketamine and propofol combination may be the best method to achieve general anaesthesia in the ECT setting. There is a need for large randomised prospective studies comparing the effect of methohexital, thiopental, propofol, ketamine, propofol+ketamine 1 : 1 and etomidate in the ECT treatment of major depressed patients. These studies should investigate safety and side effects, and most importantly have antidepressant efficacy and cognitive side effects as outcome measures instead of seizure quality.

scholarly journals Repetitive transcranial magnetic stimulation treatment for peripartum depression: systematic review & meta-analysis

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Hyune June Lee ◽  
Sung Min Kim ◽  
Ji Yean Kwon
Keyword(s):  
Systematic Review ◽  
Transcranial Magnetic Stimulation ◽  
Side Effects ◽  
Electroconvulsive Therapy ◽  
Effect Size ◽  
Magnetic Stimulation ◽  
Repetitive Transcranial Magnetic Stimulation ◽  
Meta Analysis ◽  
Cochrane Library ◽  
Peripartum Depression

Abstract Background Peripartum depression is a common disorder with very high potential hazards for both the patients and their babies. The typical treatment options include antidepressants and electroconvulsive therapy. However, these treatments do not ensure the safety of the fetus. Recently, repetitive transcranial magnetic stimulation has emerged as a promising treatment for neuropathies as well as depression. Nevertheless, many studies excluded pregnant women. This systematic review was conducted to confirm whether repetitive transcranial magnetic stimulation was a suitable treatment option for peripartum depression. Methods We performed a systematic review that followed the PRISMA guidelines. We searched for studies in the MEDLINE, PsycINFO, EMBASE, and Cochrane library databases published until the end of September 2020. Eleven studies were selected for the systematic review, and five studies were selected for quantitative synthesis. Data analysis was conducted using Comprehensive Meta-Analysis 3 software. The effect size was analyzed using the standardized mean difference, and the 95% confidence interval (CI) was determined by the generic inverse variance estimation method. Results The therapeutic effect size of repetitive transcranial magnetic stimulation for peripartum depression was 1.394 (95% CI: 0.944–1.843), and the sensitivity analysis effect size was 1.074 (95% CI: 0.689–1.459), indicating a significant effect. The side effect size of repetitive transcranial magnetic stimulation for peripartum depression was 0.346 (95% CI: 0.214–0.506), a meaningful result. There were no severe side effects to the mothers or fetuses. Conclusions From various perspectives, repetitive transcranial magnetic stimulation can be considered an alternative treatment to treat peripartum depression to avoid exposure of fetuses to drugs and the severe side effects of electroconvulsive therapy. Further research is required to increase confidence in the results.

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.

Central Nervous System Reorganization and Pain After Spinal Cord Injury: Possible Targets for Physical Therapy—A Systematic Review of Neuroimaging Studies

2020 ◽  
Vol 100 (6) ◽  
pp. 946-962
Author(s):  
Thomas Osinski ◽  
Sessi Acapo ◽  
Djamel Bensmail ◽  
Didier Bouhassira ◽  
Valéria Martinez
Keyword(s):  
Systematic Review ◽  
Spinal Cord ◽  
Central Nervous System ◽  
Spinal Cord Injury ◽  
Nervous System ◽  
Physical Therapist ◽  
Anterior Cingulate ◽  
Current Evidence ◽  
Functional Changes ◽  
Cord Injury

Abstract Background Pain is one of the main symptoms associated with spinal cord injury (SCI) and can be associated with changes to the central nervous system (CNS). Purpose This article provides an overview of the evidence relating to CNS changes (structural and functional) associated with pain in SCIs. Data Sources A systematic review was performed, according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) recommendations, on PubMed, Embase, and Web of Science in March 2018. Study Selection Studies were selected if they concerned changes in the CNS of patients with SCI, regardless of the type of imagery. Data Extraction Data were extracted by 2 blinded reviewers. Data Synthesis There is moderate evidence for impaired electroencephalographic function and metabolic abnormalities in the anterior cingulate in patients experiencing pain. There is preliminary evidence that patients with pain have morphological and functional changes to the somatosensory cortex and alterations to thalamic metabolism. There are conflicting data regarding the relationships between lesion characteristics and pain. In contrast, patients without pain can display protective neuroplasticity. Limitations and Conclusion Further studies are required to elucidate fully the relationships between pain and neuroplasticity in patients with SCIs. However, current evidence might support the use of physical therapist treatments targeting CNS plasticity in patients with SCI pain.

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