Ultrabrief (0.3 ms) or brief (0.5 ms) pulses for right unilateral electroconvulsive therapy: is there a difference in seizure thresholds?

Objectives: To compare the minimum charge to elicit a seizure using 2 different pulse widths, the brief pulse (0.5 milliseconds [ms]) and the ultrabrief pulse (0.3 ms).

Simultaneous low (1 Hz)- and high (10 Hz)-frequency bilateral transcranial magnetic stimulation in a patient with severe depression and crohn disease.

We present a case report in which electroconvulsive therapy had a good effect for the treatment of depression in association with Crohn disease, but adverse effects limited its use. Repetitive transcranial magnetic stimulation was tried both in a conventional way (high frequency over the left dorsolateral prefrontal cortex) and in a bilateral sequential way (high frequency in the same region followed in the same session by low frequency on the right side). Finally, bilateral simultaneous stimulation (high frequency over the left and low frequency over the right side) was tried and resulted in a response similar to that of electroconvulsive therapy.

Recovery after ECT: comparison of propofol, etomidate and thiopental.

Objectives: To compare post anesthetic time for patient recovery after electroconvulsive therapy, as measured by the post anesthetic Recovery Score of Aldrete and Kroulik, using three different types of hypnotic drugs (propofol, etomidate and thiopental).

Method: Thirty patients were randomized to receive one of the three drugs (n = 10 in each group), during a course of electroconvulsive therapy treatment. Patients and raters were blinded to which drug was received.

Effects of repetitive transcranial magnetic stimulation on auditory hallucinations refractory to clozapine.

Objective: To study the therapeutic effects on auditory hallucinations refractory to clozapine with 1-Hz repetitive transcranial magnetic stimulation (rTMS) applied on the left temporoparietal cortex.

Method: Eleven patients with schizophrenia (DSM-IV) experiencing auditory hallucinations (unresponsive to clozapine) were randomly assigned to receive either active of rTMS (N = 6) or sham stimulation (N = 5) (with concomitant use of clozapine) using a double-masked, sham-controlled, parallel design. A total of 160 minutes of rTMS (9600 pulses) was administered over 10 days at 90% motor threshold.

Cardiovascular effects of anesthesia in ECT: a randomized, double-blind comparison of etomidate, propofol, and thiopental.

Cardiovascular alterations during electroconvulsive therapy (ECT) are a major concern for this treatment. Although several studies have been performed to compare the effects of anesthetics on these alterations, the results are mixed and doubt still exists regarding the choice of the best drug. We conducted a randomized, double-blind clinical trial to compare the effects of 3 anesthetics used in ECT: etomidate, propofol, and thiopental.

Accidental seizure with repetitive transcranial magnetic stimulation.

Accidental induction of convulsions by using repetitive transcranial magnetic stimulation (rTMS) has been reported to have occurred in 6 normal voluntary subjects, in 1 patient with depression and in 1 patient who had temporal lobe epilepsy, with secondary generalization. In addition, 3 other cases have been published relating its use with seizure induction and in 1 case, using 1-Hz stimulation. In this paper, we report a patient who was participating in a protocol for the use of rTMS in chronic pain, with stimulation in the motor cortex, who developed a generalized seizure in the fifth application.

Open trial on the efficacy of right unilateral electroconvulsive therapy with titration and high charge.

The use of right unilateral electrode placement for electroconvulsive therapy (ECT) is one of the most important developments on the technique because it is considered to spare cognition. Nevertheless, the best way to determine the charge to be given to the individual patient is still controversial. We present an open study on the use of right unilateral ECT using the technique of method of limits and giving treatments with 6 times the seizure threshold.

Comparison of repetitive transcranial magnetic stimulation and electroconvulsive therapy in unipolar non-psychotic refractory depression: a randomized, single-blind study.

Repetitive transcranial magnetic stimulation (rTMS) can induce significant antidepressant effects and, for some patients, might be an alternative to electroconvulsive therapy (ECT). The results of studies comparing the efficacy of rTMS and ECT are mixed and, therefore, comparison of these two therapies needs to be further explored. Forty-two patients aged between 18 and 65 yr, referred to ECT due to unipolar non-psychotic depression refractoriness entered the trial.

Transcranial magnetic stimulation accelerates the antidepressant effect of amitriptyline in severe depression: a double-blind placebo-controlled study.

Background: Transcranial magnetic stimulation (TMS) is a noninvasive method to stimulate the cortex, and the treatment of depression is one of its potential therapeutic applications. Three recent meta analyses strongly suggest its benefits in the treatment of depression. The present study investigates whether repetitive TMS (rTMS) accelerates the onset of action and increases the therapeutic effects of amitriptyline.