Pogarell O, Ehrentraut S, Rüther T, Mulert C, Hegerl U, Möller H-J, Henkel V
Department of Psychiatry, Ludwig-Maximilians-University of Munich, Munich, Germany.
Pharmacopsychiatry. 2005 Nov;38(6):316-20. doi: 10.1055/s-2005-916187.
Cognitive impairment occasionally occurs after electroconvulsive therapy (ECT) and usually resolves within a few days. Any prolonged cognitive alterations or confusional states may have additional causes and require extensive diagnostic effort. Since cognitive dysfunction can also be caused by ictal states, electroencephalography (EEG) is an essential tool for these conditions.
We report on a female patient with pharmacotherapy resistant major depression who had been treated by a series of ECT and subsequently developed severe confusion and fluctuating amnesia.
Laboratory and neuroimaging examinations were normal, however, EEG revealed a severe intermittent slowing with rhythmic high amplitude delta-/theta-activity and sporadic bitemporal sharp waves. Oral application of 1 mg lorazepam led to a sudden improvement of EEG abnormalities. Consequently, non-convulsive status epilepticus (NCSE) was suspected and the patient was regularly treated with lorazepam, accordingly. Clinically the confusional and amnesic symptoms declined, whereas serial EEG recordings showed a further improvement and normalization of brain electric activity.
Routine EEG is an indispensable tool in patients with sudden deterioration of cognitive functions and unclear neuropsychiatric symptomatology. A testing dose of lorazepam can help to classify EEG abnormalities in terms of ictal EEG patterns.
认知障碍偶尔会在电休克治疗（ECT）后出现，通常在几天内就会缓解。任何长期的认知改变或意识模糊状态可能有其他原因，需要进行广泛的诊断。由于认知功能障碍也可能由发作期状态引起，脑电图（EEG）是诊断这些情况的重要工具。
我们报告了一名患有药物治疗抵抗性重度抑郁症的女性患者，她接受了一系列ECT治疗，随后出现了严重的意识模糊和波动性失忆。
实验室检查和神经影像学检查均正常，然而，脑电图显示严重的间歇性减慢，伴有节律性高幅δ/θ活动和散在的双侧颞叶尖波。口服1毫克劳拉西泮后，脑电图异常突然改善。因此，怀疑为非惊厥性癫痫持续状态（NCSE），并相应地对患者进行了劳拉西泮常规治疗。临床上，意识模糊和失忆症状有所减轻，而系列脑电图记录显示脑电活动进一步改善并恢复正常。
对于认知功能突然恶化且神经精神症状不明确的患者，常规脑电图是不可或缺的工具。一剂试验性的劳拉西泮有助于根据发作期脑电图模式对脑电图异常进行分类。
