What Is Brain Damage and Does Electroconvulsive Therapy Cause It?

Surveys show public misperceptions and confusion about brain damage and electroconvulsive therapy (ECT). Fictional movies have misrepresented ECT to suggest brain damage and to ridicule mental illness and psychiatric patients. "Brain damage" has become a colloquial expression without consistent meaning.

A mechanism of seizure induction by electricity and its clinical implications.

A model of ECT seizure induction by rapid kindling is described. The electrical stimulus as a series of pulses progressively disrupts neuronal cell membranes, with corresponding progressive increases in intracellular concentrations of sodium, calcium, and voltage. Eventually, the intracellular voltage rises to trigger neuronal firing in waves from seizure foci.

Age-based seizure threshold determination.

Objective: The intent was to improve seizure threshold titration by decreasing stimuli number.

Method: An age-based method of titration for initial seizure threshold bilateral electroconvulsive therapy was constructed and used in 15 women and 9 men aged 35 to 80 years. Titration steps were one eighth, one fourth, three eighths, one half, five eighths, three fourths, 1, and 1.

ECT stimulus dose dependence on current separately from charge.

Bilateral electroconvulsive therapy (ECT) seizure threshold charge averaged 162.8 and 125.1 mC at 900 and 1150 mA, respectively (p<0.

Clinically insubstantial cognitive side effects of bitemporal electroconvulsive therapy at 0.5 msec pulse width.

Background: We measured cognitive side effects from bitemporal electroconvulsive therapy (ECT) using stimuli of 0.5 msec pulse width 900 milliamperes (mA).

Methods: Mini-Mental State Exam (MMSE) and 21-item Hamilton Rating Scale for Depression (HRSD-21) were rated within 36 hours before and 36 hours after a series of 6 bitemporal ECT sessions on 15 patients age ≥45.

Propofol interruption of ECT seizure to reduce side-effects: a pilot study.

Fifteen depressed subjects received six bitemporal electroconvulsive therapy (ECT) treatments under etomidate anesthesia. They were randomized to blindly either receive propofol 0.5mg/kg 15s post-stimulus or not.

ECT generalized seizure drives heart rate above treadmill stress test maximum.

Objectives: Heart rate (HR) accelerates with the electroconvulsive therapy (ECT) seizure and decelerates when it ends. The peak HR during ECT seizure has been reported to reflect clinical impact. We aimed to identify the expected range for ECT peak HR and how it varies with age and sex, as a reference in clinical use.

Carvedilol suppresses intractable hiccups.

Carvedilol (6.25 mg, 4 times daily) relieved 2 years of constant hiccupping, marked tardive dyskinesia, compulsive self-induced vomiting, and feelings of hopelessness and low mood in a 59-year-old African-American man. He previously failed trials of ranitidine, chlorpromazine, promethazine, tegaserod, ondansetron, metoclopramide, pantoprazole, pyloric injections of botulinum toxin A, and a vagal nerve stimulator.

Electroconvulsive therapy stimulus dose expressed as volume of seizure foci.

Background: Electrical stimulus dose is typically stated as charge in millicoulombs (mC), representing the number of electrons. However, by overlooking the voltage threshold for neuronal depolarization, charge alone is inappropriate. Any charge can accumulate from subthreshold voltage over time.

Dystonic rabbit syndrome from citalopram.

Objective: Two cases are described of dystonic rabbit syndrome induced by citalopram. This syndrome is a movement disorder with a 5-Hz rhythmic vertical motion of the mouth and lips without involvement of the tongue.

Method: The patients were interviewed and examined, and additional history was taken from the medical records.

Rational electroconvulsive therapy electrode placement.

Expertise in medicating depression requires experience with all types of antidepressants, including several medications within each type. Likewise, electroconvulsive therapy (ECT) proficiency includes experience with each of the modern electrode placements, of which there are four. Besides traditional bilateral and right unilateral placements, ECT electrode placement includes bifrontal and left anterior right temporal (LART) placements.

Diminished ECT response in catatonia due to chronic neurologic condition.

A series of four clinical cases suggests that catatonic disorder due to a chronic neurologic condition does not respond as reliably to electroconvulsive therapy (ECT) as functional catatonia does. Cases reported in the medical literature show a similar pattern. Presumably this form of catatonia is intrinsically less responsive to ECT, although the possibility remains that a more intense quality of treatment and prophylaxis is needed.

Postictal asystole during ECT.

Background: Asystole is an uncommon but potentially fatal complication of electroconvulsive therapy (ECT). Several risks for poststimulus asystole have been described, but risks for asystole at other times have not.

Method: Two instances of ECT postictal asystole in healthy adult males are reported.