White Paul F, Amos Quinlan, Zhang Yunan, Stool Louis, Husain Mustafa M, Thornton Larry, Downing Michael, McClintock Shawn, Lisanby Sarah H
Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX 75390-9068, USA.
Anesth Analg. 2006 Jul;103(1):76-80, table of contents. doi: 10.1213/01.ane.0000221182.71648.a3.
Electroconvulsive therapy (ECT) is a highly effective treatment for severe depression. However, its use is associated with significant posttreatment cognitive impairment. Magnetic seizure therapy (MST) was developed as an alternative therapy that could reduce postseizure side effects through the induction of more "focal" seizure activity. Using an open-parallel study design, we compared 20 case-matched patients undergoing a series of either ECT or MST procedures with respect to their anesthetic, muscle relaxant, and cardiovascular drug requirements, effects on cardiovascular and electroencephalographic bispectral index (BIS) values, and early recovery times. We found that MST was associated with a reduced time to orientation (4 +/- 1 versus 18 +/- 5 min; P < 0.01) compared with ECT. To minimize residual muscle paralysis after MST, a reduction in the succinylcholine dosage (38 +/- 17 versus 97 +/- 2 mg; P < 0.01) was required. The BIS values were higher before, and lower immediately after, the stimulus was applied in the MST (versus ECT) group. The Hamilton depression rating scale score was significantly reduced from the baseline value in both treatment groups; however, the posttreatment score was lower after the series of ECT treatments (6 +/- 6 versus 14 +/- 10; P < 0.05). We conclude that MST was associated with a decreased requirement for muscle relaxants, reduced variability in the BIS values after seizure induction, and a more rapid recovery of cognitive function compared with ECT. Further studies are required to evaluate the antidepressant efficacy of MST versus ECT when they are administered at comparable levels of cerebral stimulation.
电休克疗法（ECT）是治疗重度抑郁症的一种高效疗法。然而，其使用与治疗后显著的认知障碍有关。磁休克疗法（MST）作为一种替代疗法而被研发出来，它可通过诱导更“局灶性”的癫痫发作活动来减少癫痫发作后的副作用。采用开放平行研究设计，我们比较了20例病例匹配的患者，这些患者分别接受了一系列ECT或MST治疗，比较内容包括他们对麻醉剂、肌肉松弛剂和心血管药物的需求、对心血管和脑电图双谱指数（BIS）值的影响以及早期恢复时间。我们发现，与ECT相比，MST与定向恢复时间缩短有关（4±1分钟对18±5分钟；P<0.01）。为了使MST后残留的肌肉麻痹最小化，需要减少琥珀酰胆碱的剂量（38±17毫克对97±2毫克；P<0.01）。在MST（与ECT相比）组中，刺激施加前BIS值较高，刺激施加后立即降低。两个治疗组的汉密尔顿抑郁评定量表评分均较基线值显著降低；然而，在一系列ECT治疗后，治疗后评分更低（6±6对14±10；P<0.05）。我们得出结论，与ECT相比，MST与肌肉松弛剂需求减少、癫痫发作诱导后BIS值变异性降低以及认知功能恢复更快有关。当以相当的脑刺激水平给药时，需要进一步研究来评估MST与ECT的抗抑郁疗效。
