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电休克刺激参数的脑电图频谱效应:优化电休克治疗刺激的理论依据的发展

Spectral EEG effects of electroconvulsive shock stimulus parameters: the development of a rationale for the optimization of the ECT stimulus.

作者信息

Sudha S, Andrade Chittaranjan, Mukundan C R, Chandra J Suresh

机构信息

Department of Pharmacology, St. John's Medical College, Bangalore, India.

出版信息

J ECT. 2003 Dec;19(4):197-210. doi: 10.1097/00124509-200312000-00005.

Abstract

BACKGROUND

Electroconvulsive therapy (ECT) stimulus parameters, such as pulse amplitude, pulse width, pulse frequency, and stimulus duration, differently influence seizure threshold and, possibly, other neurobiological effects of ECT. We examined the influence of these parameters on the EEG power spectrum in an animal model.

METHODS

Adult, male, Wistar rats (n=54) were randomized to receive one of five differently constituted (approximately) 30-mC electroconvulsive shock (ECS) stimuli administered once on alternate days for a total of three ECS. A single-lead, unipolar EEG recording was obtained before, during, and immediately after each ECS seizure. EEG power was computed in eight frequency bands from 2 to 40 Hz. Greater ictal EEG power, greater postictal EEG suppression, and greater interictal EEG power, especially in lower frequency bands, were a priori defined as proxies of seizure efficacy.

RESULTS

Motor and EEG seizure duration and a proxy for seizure generalization did not differ significantly across the five stimulus groups. Despite equivalent charge, the five stimuli varied widely in their effects on the EEG proxies of seizure efficacy. The narrow (0.6 milliseconds) pulse width, high (100 Hz) pulse frequency combination was best associated with EEG proxies of seizure efficacy; with this combination, a longer stimulus train duration appeared superior to a greater pulse amplitude. The wide (2 milliseconds) pulse and low (30 Hz) frequency combination was least associated with EEG proxies of efficacy. Stimulus "on" time, number of pulses delivered, and the rate of delivery of charge were not associated with the EEG proxies; the former finding questions the validity of dosing ECT in units of charge.

CONCLUSIONS

These findings suggest a rationale for optimizing stimulus parameter choices during ECT and provide a framework for the evaluation of electrical aspects of the ECT stimulus.

摘要

背景

电休克治疗(ECT)的刺激参数,如脉冲幅度、脉冲宽度、脉冲频率和刺激持续时间,对癫痫阈值以及ECT可能的其他神经生物学效应有不同影响。我们在动物模型中研究了这些参数对脑电图功率谱的影响。

方法

将成年雄性Wistar大鼠(n = 54)随机分为五组,分别接受五种不同构成的(约)30 mC电惊厥休克(ECS)刺激,隔日进行一次,共进行三次ECS刺激。在每次ECS发作前、发作期间和发作后立即进行单导联单极脑电图记录。计算2至40 Hz八个频段的脑电图功率。发作期脑电图功率增强、发作后期脑电图抑制增强以及发作间期脑电图功率增强,尤其是在低频段,被预先定义为癫痫发作疗效的指标。

结果

五个刺激组的运动和脑电图发作持续时间以及癫痫发作泛化指标无显著差异。尽管电荷量相等,但这五种刺激对癫痫发作疗效的脑电图指标影响差异很大。窄(0.6毫秒)脉冲宽度、高(100 Hz)脉冲频率组合与癫痫发作疗效的脑电图指标相关性最佳;采用这种组合时,较长的刺激串持续时间似乎优于更大的脉冲幅度。宽(2毫秒)脉冲和低(30 Hz)频率组合与疗效的脑电图指标相关性最小。刺激“开启”时间、输送的脉冲数和电荷输送速率与脑电图指标无关;前一发现质疑了以电荷量为单位对ECT进行剂量计算的有效性。

结论

这些发现为优化ECT期间的刺激参数选择提供了理论依据,并为评估ECT刺激的电学方面提供了框架。

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