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The effect of ECT on quantitative EEG and spect measures
THURSDAY,, MAY 19
BIOL PSYCHIATRY
653
1994;35:61.5-747
uncommon, there are no established guidelines for its practice. Many practitioners follow fixed schedules and others treat the patients when they become symptomatic (Kramer, 1987). On a retrospective chart review of the C-ECT practice in our institution we found that the average frequency of C-ECT was 9.6 days and the typical duration about three months. Based on these data we designed a prospective study to determine practicability and frequency for C-ECT. Fourteen patients with major depression who were successfully treated with ECT were enrolled in the study. Eight of them were randomly assigned to a biweekly treatment schedule for three months (6 treatments) and six were assigned to a weekly schedule for the same period (! 2 treatments). Compliance, relapse rate and side effects were the outcome measures. Seven of eight patients (87%) assigned to biweekly schedule and three of six (50%) of the weekly schedule completed the study to date. Poor compliance was the reason for early termination in four cases (I biweekly and 3 weekly). None of the patients relapsed during the three month period. Biweekly C-ECT is practical, more tolerable to patients than weekly C-ECT, and has the same efficacy in preventing relapse for at least a three month period.
138. THE HALF-AGE STIMULATION STRATEGY FOR BILATERAL ECT
eleetroconvuisive therapy (ECT) have yet to be defined. ECT has potent anticonvulsant effects (documented mainly in experimental animal studies, using electroconvulsive shock, ECS); one hypothesized mechanism of ECT's antidepressant efficacy implicates this anficonvulsant property. We conducted the present study to address the following questions raised by this hypothesis: 1) Does ECT have anficonvulsant effects that can be easily documented in the clinical setting? 2) Is this anticonvulsant effect influenced by electrode placement and other stimulus parameters? 3) is there any relationship between this anticonvulsant effect and clinical response? We studied 75 patients who received at least six treatments in a course of ECT for major depression. ECT stimulus parameters were clinically determined. Two measures were hypothesized to reflect anficonvulsant property: 1) reduction in seizure duration for the same stimulus (same amount of energy, etc.) in a given patient; and 2) pattern of EEG seizure termination. Preliminary analyses reveal a progressive reduction in seizure duration and no substantial change in the manner of EEG seizure termination through a course of ECT. No relationship between these measures was observed. There was a weak relationship between Wogressire shortening of seizure duration and antidepressant'effect; patients who showed a greater shortening of seizure duration showed a greater reduction in Hamilton depression scores. These data suggest that the anticon. vuisant property of ECT may be t~elevantto its effectiveness in treating depression. Detailed analyses will be presented and the clinical and pathophysiological implications of these data will be discussed.
G. Petrides & M. Fink Department of Psychiatry, SUNY at Stony Brook, NY Electrical dosing in bilateral ECT is currently based on two methods: an estimate from the patient's age (Abrams, 1988), and an individualized dose titration method (Sackeim, 1991). The age estimate has been criticized for occasional administration of suprathreshold stimuli, which are believed to produce excessive cognitive effects. The dose titration method requires multiple stimulations within the same session, which may prolong anaesthesia. The effects of multiple subthreshold stimuli on cognition and outcome are not known. Based on data from 90 patients treated with bilateral ECT with dose titration, we devised an alternate strategy (half-age strategy), which is simpler and may avoid over-dosing and repeated stimulations. Energy dosage is determined as the half of the patient's age expressed in percent of energy (Thymatron), or in Joules (MECTA). The half age is rounded up to the next higher scale point for the Thymatmn, or to the next higher number that ends with 5 or 0 for the MECTA. We initially treated 28 patients with this strategy. Each stimulation provoked a seizure, compared to an average of 2.4 stimulations for the titration method. The average duration of first treatment was 50.7" (cuff) and 97.1" (EEG). All the patients recovered after an average of 9.3 treatments. Eighteen more patients were randomly assigned to an A-B or B-A scheme for their first and second treatment ( A-titration, B-halfage). Dosing by the half-age method was successful and the delivered energy was an average of 15% above threshold as determined by the titration method.
139. ANT!CONVULSANT EFFECTS OF ELECTROCONVULSIVE THERAPY: RELATIONSHIP TO ANTIDEPRESSANT ACTIVITY H. Kales, D. Maixner, J.R. DeQuardo, A. Miller, & R. Tandon ECT Program, University of Michigan Medical Arbor, MI 48109-0116
Center, Ann
The biological mechanisms respor~siblefor the antidepressant effects of
140. THE EFFECT OF ECT ON QUANTITATIVE EEG AND SPECT MEASURES L.M. Konopka t.3, J.W. Crayton 1,3, K. Kumarl, P. Shirazi 2, F.J. Papatheofanis 2, F.J. O'Connor I, & T. Milo 2 t Biological Psychiatry Section, and 2Nuclear Medicine Service, Hines VA Hospital, Hines, IL 60141; 3Loyola-Stritch School of Medicine, Maywood, IL 60153 Electroconvulsive therapy (ECF) continues to be the treatment of choice for depressive disorders refractory to pharmacotherapy, but the mechanisms underlying its therapeutic effects are not clearly understood. In order to examine the effects of ECT on EEG and SPECT measures, we studied ! 8 severely depressed patients before and within 4 days after a course of ECT. Previous studies have documented some EEG effects of ECT. For example, repeated treatments result in the appearance of persistent slowing and a generalized increase in the amplitude of the EEG signal (Chusid and Pacella 1952; Fink and Kahn 1957; Ottoson 1960) and a corresponding rednction in fast activity (Kolbeinsson and Petursson 1988). Previous perfusion studies have suggested that there is a generalized hypoperfusion of brain (as assessed by xenon peffusion studies) following a course of ECT (Siifverskiold, et al 1987). We conducted studies utilizing a newly.developed method of quantitative EEG acquisition which allows a direct temporal comparison of EEG measures during the injection and distrib~ltion of the brain SPI.~CT perfusion indicator, HMPAO. Clinical improvement as assessed by the Global Clinical Impression Scale showed that 15 of the ! 8 patients showed significant improvement. Both responders and nonresponders demonstrated a significant shift in the peak of the dominant frequencies from 9:, to 8.4 Hz (p -0.0081). Both groups also showed an increase in the total global power from 2118.5 to 4071.9 StV2 (p -0.0002). SPECT findings showed that 8 of 15 clinical responders had enhanced peffusion post-treatment; ! showed no change in perfusion; and 6 showed decreased perfusion. These findings indicate that there is not a simple relationship between SPECT perfusion data and neuronal activity in ECT patients.
BIOL PSYCHIATRY
653
1994;35:61.5-747
uncommon, there are no established guidelines for its practice. Many practitioners follow fixed schedules and others treat the patients when they become symptomatic (Kramer, 1987). On a retrospective chart review of the C-ECT practice in our institution we found that the average frequency of C-ECT was 9.6 days and the typical duration about three months. Based on these data we designed a prospective study to determine practicability and frequency for C-ECT. Fourteen patients with major depression who were successfully treated with ECT were enrolled in the study. Eight of them were randomly assigned to a biweekly treatment schedule for three months (6 treatments) and six were assigned to a weekly schedule for the same period (! 2 treatments). Compliance, relapse rate and side effects were the outcome measures. Seven of eight patients (87%) assigned to biweekly schedule and three of six (50%) of the weekly schedule completed the study to date. Poor compliance was the reason for early termination in four cases (I biweekly and 3 weekly). None of the patients relapsed during the three month period. Biweekly C-ECT is practical, more tolerable to patients than weekly C-ECT, and has the same efficacy in preventing relapse for at least a three month period.
138. THE HALF-AGE STIMULATION STRATEGY FOR BILATERAL ECT
eleetroconvuisive therapy (ECT) have yet to be defined. ECT has potent anticonvulsant effects (documented mainly in experimental animal studies, using electroconvulsive shock, ECS); one hypothesized mechanism of ECT's antidepressant efficacy implicates this anficonvulsant property. We conducted the present study to address the following questions raised by this hypothesis: 1) Does ECT have anficonvulsant effects that can be easily documented in the clinical setting? 2) Is this anticonvulsant effect influenced by electrode placement and other stimulus parameters? 3) is there any relationship between this anticonvulsant effect and clinical response? We studied 75 patients who received at least six treatments in a course of ECT for major depression. ECT stimulus parameters were clinically determined. Two measures were hypothesized to reflect anficonvulsant property: 1) reduction in seizure duration for the same stimulus (same amount of energy, etc.) in a given patient; and 2) pattern of EEG seizure termination. Preliminary analyses reveal a progressive reduction in seizure duration and no substantial change in the manner of EEG seizure termination through a course of ECT. No relationship between these measures was observed. There was a weak relationship between Wogressire shortening of seizure duration and antidepressant'effect; patients who showed a greater shortening of seizure duration showed a greater reduction in Hamilton depression scores. These data suggest that the anticon. vuisant property of ECT may be t~elevantto its effectiveness in treating depression. Detailed analyses will be presented and the clinical and pathophysiological implications of these data will be discussed.
G. Petrides & M. Fink Department of Psychiatry, SUNY at Stony Brook, NY Electrical dosing in bilateral ECT is currently based on two methods: an estimate from the patient's age (Abrams, 1988), and an individualized dose titration method (Sackeim, 1991). The age estimate has been criticized for occasional administration of suprathreshold stimuli, which are believed to produce excessive cognitive effects. The dose titration method requires multiple stimulations within the same session, which may prolong anaesthesia. The effects of multiple subthreshold stimuli on cognition and outcome are not known. Based on data from 90 patients treated with bilateral ECT with dose titration, we devised an alternate strategy (half-age strategy), which is simpler and may avoid over-dosing and repeated stimulations. Energy dosage is determined as the half of the patient's age expressed in percent of energy (Thymatron), or in Joules (MECTA). The half age is rounded up to the next higher scale point for the Thymatmn, or to the next higher number that ends with 5 or 0 for the MECTA. We initially treated 28 patients with this strategy. Each stimulation provoked a seizure, compared to an average of 2.4 stimulations for the titration method. The average duration of first treatment was 50.7" (cuff) and 97.1" (EEG). All the patients recovered after an average of 9.3 treatments. Eighteen more patients were randomly assigned to an A-B or B-A scheme for their first and second treatment ( A-titration, B-halfage). Dosing by the half-age method was successful and the delivered energy was an average of 15% above threshold as determined by the titration method.
139. ANT!CONVULSANT EFFECTS OF ELECTROCONVULSIVE THERAPY: RELATIONSHIP TO ANTIDEPRESSANT ACTIVITY H. Kales, D. Maixner, J.R. DeQuardo, A. Miller, & R. Tandon ECT Program, University of Michigan Medical Arbor, MI 48109-0116
Center, Ann
The biological mechanisms respor~siblefor the antidepressant effects of
140. THE EFFECT OF ECT ON QUANTITATIVE EEG AND SPECT MEASURES L.M. Konopka t.3, J.W. Crayton 1,3, K. Kumarl, P. Shirazi 2, F.J. Papatheofanis 2, F.J. O'Connor I, & T. Milo 2 t Biological Psychiatry Section, and 2Nuclear Medicine Service, Hines VA Hospital, Hines, IL 60141; 3Loyola-Stritch School of Medicine, Maywood, IL 60153 Electroconvulsive therapy (ECF) continues to be the treatment of choice for depressive disorders refractory to pharmacotherapy, but the mechanisms underlying its therapeutic effects are not clearly understood. In order to examine the effects of ECT on EEG and SPECT measures, we studied ! 8 severely depressed patients before and within 4 days after a course of ECT. Previous studies have documented some EEG effects of ECT. For example, repeated treatments result in the appearance of persistent slowing and a generalized increase in the amplitude of the EEG signal (Chusid and Pacella 1952; Fink and Kahn 1957; Ottoson 1960) and a corresponding rednction in fast activity (Kolbeinsson and Petursson 1988). Previous perfusion studies have suggested that there is a generalized hypoperfusion of brain (as assessed by xenon peffusion studies) following a course of ECT (Siifverskiold, et al 1987). We conducted studies utilizing a newly.developed method of quantitative EEG acquisition which allows a direct temporal comparison of EEG measures during the injection and distrib~ltion of the brain SPI.~CT perfusion indicator, HMPAO. Clinical improvement as assessed by the Global Clinical Impression Scale showed that 15 of the ! 8 patients showed significant improvement. Both responders and nonresponders demonstrated a significant shift in the peak of the dominant frequencies from 9:, to 8.4 Hz (p -0.0081). Both groups also showed an increase in the total global power from 2118.5 to 4071.9 StV2 (p -0.0002). SPECT findings showed that 8 of 15 clinical responders had enhanced peffusion post-treatment; ! showed no change in perfusion; and 6 showed decreased perfusion. These findings indicate that there is not a simple relationship between SPECT perfusion data and neuronal activity in ECT patients.