|
|
新型电休克疗法克服认知损伤副作用
据新一期爱思唯尔期刊《大脑刺激》（BRAIN STIMULATION）报道，一种新型电休克疗法在保持传统电休克疗法效果的同时，克服了认知损伤副作用。哥伦比亚大学的科学家Harold Sackeim 和同事对90名抑郁症患者随机地实施了单侧或双侧脑电休克疗法，其中一部分使用传统的电休克疗法，另一部分使用采用“ultrabrief pulse”电流的新疗法，并跟踪观察了临床治疗效果和认知副作用的发生情况。
研究结果显示，在实施新型电休克疗法的患者组，73%的患者症状有所改善；在实施传统电休克疗法的患者组治疗有效率是65%。令人兴奋的是，相比传统疗法，新疗法出现的严重认知损伤副作用少了很多。文章中写道：“新疗法明显减少了认知损伤副作用，同时也保持了传统疗法的治疗效果。”
同期的一篇评论中，以色列精神病学家Bernard Lerer博士写道：“Sackeim博士和同事的文章表明，新疗法克服了副作用，保持了疗效。研究结果通过随机控制实验得到，有说服力。如果能得到进一步实验和临床研究的验证，该疗法将成为电休克疗法的重要进步。Sackeim博士的研究还深化了我们对电休克疗法治疗机理的认识。自抽搐治疗产生至今已有73年，该疗法治疗机理依然是个医学难题。该研究成果是电休克疗法的显著优化，可能成为攻克抑郁症或其他精神疾病治疗难关的关键一步。”
同期的一篇评论从物理学的角度解释了大脑刺激疗法，文章作者克利夫兰的生物医学工程师Cameron McIntyre博士在评论中写道：“对电休克疗法参数的分析结果显示，我们需要重新思考电休克疗法的临床治疗标准，应该将科学研究与临床评价相结合，进一步优化电休克疗法。”
《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.)
选自链接：http://blog.sina.com.cn/s/blog_4b352ce10100a3be.html |
|
楼主: 长裙
雷达卡
发表于 08-2-16 21:07:14
