Poulet E, Auriacombe M, Tignol J
Groupe d'étude de l'ECT, Laboratoire de Psychiatrie, IFR de Neurosciences Cliniques et Expérimentales (INSERM-IFR no. 8 et CNRS-FR no. 13), Université Victor-Segalen, Bordeaux 2, Bordeaux.
Encephale. 2003 Mar-Apr;29(2):99-107.
To induce a seizure for electroconvulsive therapy (ECT), an electrical charge is delivered above seizure threshold. The means and criteria used to determine the electrical dosage are subject to debate. Nonetheless this is an important issue because effectiveness and side effects have been shown to be influenced by the electrical charge used. The objective is to review data available in the literature on seizure threshold and ECT and determine the eventual consequences for practical determination of stimulus dosing. A comprehensive review of the literature is based on the search of electronic databases (Medline, INSIT) and a manual search; 72 references out of a total of 96 selected were used for this review. Seizure threshold varies widely between subjects receiving ECT (600% mean variation), however a majority of subjects of all ages have a threshold below 150 mC. Only a few individuals have very high thresholds (400 to 800 mC). ECT has an anticonvulsive effect as threshold increases during a course of ECT. Many factors influence threshold and all are not known. Among those that have been documented are: the characteristics of the current used (longer stimulus duration with same dosage gives lower thresholds); electrode placement (bilateral gives higher thresholds than unilateral placement); age (explains 12 to 26% of threshold variance); gender (which inconsistently gives higher thresholds for males); and other factors such as anesthetic drugs, concurrent psychotropics, and some morphological characteristics. Different methods are used to determine an individually adapted dosage. Two are recommended: titration and age. The age method is based on the fact that age is an important factor influencing threshold. The titration method is based on the observation of a very important variation in threshold between individuals that is not explained by age. We discuss the pros and cons of each method.
为了在电休克治疗（ECT）中诱发癫痫发作，会给予高于癫痫发作阈值的电荷。用于确定电剂量的方法和标准存在争议。尽管如此，这仍是一个重要问题，因为已表明有效性和副作用会受到所用电荷量的影响。目的是回顾文献中关于癫痫发作阈值和ECT的数据，并确定对刺激剂量实际测定的最终影响。基于对电子数据库（Medline、INSIT）的检索和手动检索进行文献综述；本综述共使用了从96篇选定文献中筛选出的72篇参考文献。接受ECT治疗的患者之间癫痫发作阈值差异很大（平均差异600%），然而所有年龄段的大多数患者阈值都低于150毫库仑。只有少数个体具有非常高的阈值（400至800毫库仑）。在ECT治疗过程中，随着阈值升高，ECT具有抗惊厥作用。许多因素会影响阈值，而且并非所有因素都为人所知。其中已记录的因素有：所用电流的特性（相同剂量下刺激持续时间越长，阈值越低）；电极放置（双侧放置比单侧放置阈值更高）；年龄（可解释阈值差异的12%至26%）；性别（男性阈值较高，但结果不一致）；以及其他因素，如麻醉药物、同时使用的精神药物和一些形态学特征。使用不同方法来确定个体适应剂量。推荐两种方法：滴定法和年龄法。年龄法基于年龄是影响阈值的重要因素这一事实。滴定法基于观察到个体之间阈值存在非常重要的差异，而这种差异无法用年龄来解释。我们讨论了每种方法的优缺点。
