Scalia Jason, Lisanby Sarah H, Dwork Andrew J, Johnson James E, Bernhardt Elisabeth R, Arango Victoria, McCall W Vaughn
Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, NY 10032, USA.
J ECT. 2007 Jun;23(2):96-8. doi: 10.1097/YCT.0b013e31804bb99d.
Whereas pathological seizure states, such as temporal lobe epilepsy, are commonly associated with cell loss and glial scarring in the hippocampus, seizures induced via electroconvulsive therapy (ECT) have not been associated with histological evidence of neuronal damage. We present a case report including the late-life medical history and postmortem histology of an elderly woman with major depression who received 91 sessions of ECT during the last 22 years of her life. Given the large number of ECT sessions, and her advanced age, this case provides a strong test of whether ECT causes detectable evidence of neuronal damage. We examined the gross morphology of the hippocampus, hippocampal cytoarchitecture, and measures of neuropathology. We found no pathological changes that could be attributed to ECT. Only expected, age-related features were present. Corpora amylacea and rare neurofibrillary tangles were evident, but we failed to detect any obvious evidence of cell loss or gliosis. Cognition in this patient was intact as indicated by a perfect score on a Mini-Mental Status Examination administered 6 days before death at the age of 92. This case adds to the considerable evidence for the safety of ECT.
虽然病理性癫痫状态，如颞叶癫痫，通常与海马体中的细胞丢失和胶质瘢痕形成有关，但通过电休克治疗（ECT）诱发的癫痫发作并未显示出神经元损伤的组织学证据。我们报告一例病例，包括一名患有重度抑郁症的老年女性的晚年病史和死后组织学检查结果，该患者在其生命的最后22年中接受了91次ECT治疗。鉴于ECT治疗次数众多且患者年事已高，该病例有力地检验了ECT是否会导致可检测到的神经元损伤证据。我们检查了海马体的大体形态、海马体细胞结构以及神经病理学指标。我们未发现可归因于ECT的病理变化。仅存在预期的与年龄相关的特征。淀粉样体和罕见的神经原纤维缠结明显，但我们未检测到任何明显的细胞丢失或胶质增生证据。在患者92岁去世前6天进行的简易精神状态检查中，其得分为满分，表明该患者认知功能完好。该病例进一步证明了ECT的安全性。
