Optimal Frequency for Seizure Induction with Electroconvulsive Therapy and Magnetic Seizure Therapy.

Electroconvulsive therapy (ECT) and magnetic seizure therapy (MST) are effective in the treatment of medication-resistant depression. Determining the stimulus frequency resulting in the lowest seizure threshold could produce fewer adverse effects by reducing the overall stimulus intensity. To determine the optimal frequency for seizure induction, four male rhesus macaques were titrated with an increasing number of pulses at fixed frequencies ranging from 5 to 240 pulses per second (pps) using ultrabrief-pulse right-unilateral ECT and circular-coil-on-vertex MST.

Individualized Low-Amplitude Seizure Therapy: Minimizing Current for Electroconvulsive Therapy and Magnetic Seizure Therapy.

Electroconvulsive therapy (ECT) at conventional current amplitudes (800-900 mA) is highly effective but carries the risk of cognitive side effects. Lowering and individualizing the current amplitude may reduce side effects by virtue of a less intense and more focal electric field exposure in the brain, but this aspect of ECT dosing is largely unexplored. Magnetic seizure therapy (MST) induces a weaker and more focal electric field than ECT; however, the pulse amplitude is not individualized and the minimum amplitude required to induce a seizure is unknown.

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.

Somatic treatments for mood disorders.

Somatic treatments for mood disorders represent a class of interventions available either as a stand-alone option, or in combination with psychopharmacology and/or psychotherapy. Here, we review the currently available techniques, including those already in clinical use and those still under research. Techniques are grouped into the following categories: (1) seizure therapies, including electroconvulsive therapy and magnetic seizure therapy, (2) noninvasive techniques, including repetitive transcranial magnetic stimulation, transcranial direct current stimulation, and cranial electric stimulation, (3) surgical approaches, including vagus nerve stimulation, epidural electrical stimulation, and deep brain stimulation, and (4) technologies on the horizon.

Electroconvulsive therapy stimulus parameters: rethinking dosage.

In this article, we review the parameters that define the electroconvulsive therapy (ECT) electrical stimulus and discuss their biophysical roles. We also present the summary metrics of charge and energy that are conventionally used to describe the dose of ECT and the rules commonly deployed to individualize the dose for each patient. We then highlight the limitations of these summary metrics and dosing rules in that they do not adequately capture the roles of the distinct stimulus parameters.

[Electroconvulsive therapy in major depression: current aspects].

Objective: The efficacy of electroconvulsive therapy in treating depressive symptoms has been established by means of innumerable studies developed along the last decades. Electroconvulsive therapy is the most effective biological treatment for depression currently available. The objective of this study was to demonstrate the role of electroconvulsive therapy in the treatment of depression and highlight present aspects related to its practice.

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.

Pacheco e Silva [corrected] and the origins of electroconvulsive therapy in Brazil. 1941.

There are few data about the history of electroconvulsive therapy (ECT) in many countries of the world, especially in developing ones as those of South America. This article offers a translation of an article published in 1941 by Dr Pacheco e Silva describing how ECT came to Brazil and its first use. He tells of how he learned about ECT during the 97th American Psychiatric Association Annual Meeting held in Richmond, Va, that same year, the lectures he attended, his visits to some American hospitals that were performing ECT at that time, the devices he bought, and his first experiences in using ECT in Brazil, first with dogs and, then, with patients.

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.

Evaluation of the factors interfering with drug treatment compliance among Brazilian patients with schizophrenia.

Background: Treatment noncompliance among schizophrenic patients is as high as 50%. In order to rate compliance and assess the most significant differences between compliant and noncompliant patients, a Brazilian population of schizophrenic outpatients was followed for one year.

Methods: Fifty outpatients were selected.

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.

[Transcranial magnetic stimulation: review of accidental seizures].

Transcranial magnetic stimulation (TMS) is a new technique that has been used for the treatment of neuropsychiatric disorders, specially depression. It uses a magnetic stimulator that generates a magnetic field that is applied over the patient's skull with a coil. Possible seizures may be induced accidentally by TMS.

Information for assistants of repeated transcranial magnetic stimulation.

Repeated transcranial magnetic stimulation (rTMS) is an exciting new technology being used in psychiatric and neurological research in many centres around the world. rTMS has been accepted as a routine treatment of depression in Canada and Israel. To this point, it has been exclusively conducted by medical officers.