《大脑刺激》杂志主编Mark S. George博士说:“像Sackeim博士的研究这样具有前沿性和里程碑意义的文章,再加上建设性的评论和观点,正是我们杂志希望报道的。”电休克疗法的不断进步说明,不同技术领域的知识和方法正在不断交汇和融合,这将大大推动了医学理论和实践的进步。
(生物谷bioon.com)
生物谷推荐原始出处:BRAIN STIMULATION,doi:10.1016/j.brs.2008.03.001,Harold A. Sackeim, D.P. Devanand
Effects of pulse width and electrode placement on the efficacy and cognitive effects of electroconvulsive therapy
Harold A. Sackeim PhD, a, , Joan Prudic MDa, Mitchell S. Nobler MDa, Linda Fitzsimons RNa, Sarah H. Lisanby MDa, Nancy Payne CSWa, Robert M. Berman MD, PhDa, Eva-Lotta Brakemeier MAa, Tarique Perera MDa and D.P. Devanand MDa
aDepartment of Biological Psychiatry, New York State Psychiatric Institute and the Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, NY
Background
Although electroconvulsive therapy (ECT) in major depression is effective, cognitive effects limit its use. Reducing the width of the electrical pulse and by using the right unilateral electrode placement may decrease adverse cognitive effects, while preserving efficacy.
Methods
In a double-masked study, we randomly assigned 90 depressed patients to right unilateral ECT at 6 times seizure threshold or bilateral ECT at 2.5 times seizure threshold, using either a traditional brief pulse (1.5 milliseconds) or an ultrabrief pulse (0.3 millisecond). Depressive symptoms and cognition were assessed before, during, and immediately, 2, and 6 months after therapy. Patients who responded were monitored for a 1-year period.
Results
The final remission rate for ultrabrief bilateral ECT was 35%, compared with 73% for ultrabrief unilateral ECT, 65% for standard pulse width bilateral ECT, and 59% for standard pulse width unilateral ECT (all P < .05 after covariate adjustment). The ultrabrief right unilateral group had less severe cognitive side effects than the other three groups in virtually all primary outcome measures assessed in the acute postictal period, and during and immediately after therapy. Both the ultrabrief stimulus and right unilateral electrode placement produced less short- and long-term retrograde amnesia. Patients rated their memory deficits as less severe after ultrabrief right unilateral ECT compared with each of the other three conditions (P < .001).
Conclusions
The use of an ultrabrief stimulus markedly reduces adverse cognitive effects, and when coupled with markedly suprathreshold right unilateral ECT, also preserves efficacy. (ClinicalTrials.gov number, NCT00487500.)