Safety and feasibility of magnetic seizure therapy (MST) in major depression: randomized within-subject comparison with electroconvulsive therapy.

Objective: The purpose ofthis study was to evaluate whether ECT causes structural brain damage. Method: The literature review covered the following areas: cognitive side effects, structural brain imaging, autopsies of patients who had received ECT, post-mortem studies of epileptic subjects, animal studies of electroconvulsive shock (ECS) and epilepsy, and the neuropathological effects ofthe passage ofelectricity, heat generation, and blood-brain barrier disruption. Results: ECT-induced cognitive deficits are transient, although spotty memory loss may persist for events immediately surrounding the ECT course. Prospective computerized tomography and magnetic resonance imaging studies show no evidence ofECT-induced structural changes. Some early human autopsy case reports from the unmodified ECT era reported cerebrovascular lesions that were due to agonal changes or undiagnosed disease. In animal ECS studies that used a stimulus intensity and frequency comparable to human ECT, no neuronal loss was seen when appropriate control animals, blind ratings, and perfusion fixation techniques were employed. Controlled studies using quantitative cell counts have failed to show neuronal loss even after prolonged courses ofECS. Several well-controlled studies have demonstrated that neuronal loss occurs only after 1 .5 to 2 hours ofcontinuous seizure activity in primates, and adequate muscle paralysis and oxygenation further delay these changes. These conditions are not approached during ECT. Other findings indicate that the passage of electricity, thermal effects, and the transient disruption ofthe blood-brain barrier during ECS do not result in structural brain damage. Conclusions: There is no credible evidence that ECT causes structural brain damage. (Am J Psychiatry 1994; 151:957-970)

Does ECT alter brain structure

Interventions in health psychology and behavioral medicine represent an integral area of research for the development of psychological therapies to enhance health behaviors, manage symptoms and sequelae of disease, treat psychological symptoms and disorders, prolong survival in the face of a life-threatening illness, and improve quality of life. A sampling of interventions in health psychology and behavioral medicine is offered that meet the criteria for empirically supported treatments for smoking cessation, chronic pain, cancer, and bulimia nervosa. Evidence for empirically supported treatments is identified, along with promising interventions that do not yet meet the criteria as outlined by D. L. Chambless and S. D. Hollon (1998). Evidence for the effectiveness and clinical significance of these interventions is reviewed, and issues in this area of research are outlined.

Sampling of empirically supported psychological treatments from health psychology: Smoking, chronic pain, cancer, and bulimia nervosa.

Studies of dosage, seizure threshold, and seizure duration in ECT

Magnetic seizure therapy (MST) is under development as a means of improving the cognitive side-effect profile of electroconvulsive therapy (ECT) by inducing more spatially delimited seizures that spare cortical regions involved in memory. We tested whether MST had a cognitive side-effect profile distinct from electroconvulsive shock (ECS) in a non-human primate model, using the Columbia University Primate Cognitive Profile, which has been shown to be sensitive to the cognitive effects of ECS. Using a within-subject cross-over design, daily ECS, MST, and sham (anaesthesia-only) interventions were administered in 5-wk blocks. Rhesus macaques ( n = 2) were trained on a long-term memory task, an anterograde learning and memory task, and a combined anterograde and retrograde task where learning and memory were evaluated for new and previously learned 3-item lists. Acutely following each intervention, monkeys were tested on the cognitive battery twice daily, separated by a 3-h retention interval. Overall, monkeys were least accurate following ECS ( p 's<0.05) compared to sham and MST. This effect was most marked for long-term memory of a constant target, short-term memory of a variable target and recall of previously learned 3-item lists. Monkeys were slowest to complete all tasks following ECS ( p 's=0.0001). Time to task completion following MST did not differ from sham. These findings suggest that MST results in a more benign acute cognitive side-effect profile than ECS in this model, consistent with initial observations with human MST.

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Randomized controlled trial of the cognitive side-effects of magnetic seizure therapy (MST) and electroconvulsive shock (ECS).

– The literature concerning acute changes in memory functions following electroconvulsive therapy (ECT) varying in stimulus electrode placement is reviewed. While it is clear that verbal memory deficits are greater following dominant unilateral (or bilateral) ECT than nondominant unilateral ECT, a definitive statement regarding nonverbal memory and electrode placement cannot be made due to methodological inadequacies of existing studies. The role of time before and after seizure induction is examined in relation to degree of retrograde amnesia, and possible causes of greater amnesia following bilateral than unilateral ECT are examined. Practical issues related to the choice of electrode placement are discussed.

Acute memory impairment following electroconvulsive therapy. 1. Effects of electrical stimulus waveform and number of treatments.

Studies which provide quantitative analyses of postictal disorientation following electroconvulsive therapy (ECT) are reviewed with emphasis on the variable of time since seizure induction as it relates to recovery of orientation. The studies make it clear that separable components of orientation (person, place, and time) recover at different rates following ECT. The length of disorientation tends to increase with increasing treatment number, but modifications of electrode placement (nondominant unilateral ECT) and electrical stimulus waveform (brief-pulse ECT) result in a decrease in disorientation when compared to standard bilateral sinusoidal ECT. Bilateral ECT may produce more disorientation than dominant unilateral ECT if more generalized seizures occur with the former than the latter treatment modality. Practical implications of these issues are discussed.

Recovery of orientation after electroconvulsive therapy.

In an early report ( I ) , a patient with psychogenic amnesia gave personal information during the postictal confusional state following a seizure induced by pentylenetetrazol. In 1949, Hemphill & Stuart (2) reported that a patient with “stimulated amnesia for identity” gave personal information during the postictal confusional state following electroconvulsive therapy (ECT). After the postictal state cleared, however, the amnesia was reinstated. We now report a similar case.

H. F. Crovitz

Papers

Acute memory impairment following electroconvulsive therapy. 1. Effects of electrical stimulus waveform and number of treatments.

Recovery of orientation after electroconvulsive therapy.

ECT-induced alteration of psychogenic amnesia.