Department of Psychiatry, Lokmanya Tilak Municipal Medical College and General Hospital, Sion, Bombay, India.
J ECT. 2010 Mar;26(1):23-9. doi: 10.1097/YCT.0b013e3181d2711f.
Muscle relaxants reduce musculoskeletal morbidity with electroconvulsive therapy (ECT) but need to be administered under general anesthesia. The administration of anesthesia is not always possible for patients prescribed ECT. Consequently, unmodified ECT is still widely practiced, especially in developing countries.
We prospectively assessed musculoskeletal morbidity in consecutive patients who received unmodified bitemporal ECT during a part or the whole of their ECT course. All patients were pretreated with an intravenous benzodiazepine (usually diazepam, 10 mg) to effect sedation, anxiolysis, and limited skeletal muscle relaxation. Anteroposterior and lateral digital x-rays of the thoracolumbar spine were obtained after the last unmodified treatment.
Fifty-six patients aged 11 to 49 years and with a mean body mass index of 23.0 received a total of 162 (mean, 2.9) unmodified ECTs. There was significant attenuation of psychopathology ratings. Against our expectations, no patient developed clinical or radiological evidence of orthopedic morbidity; however, in 2 patients, the x-rays revealed old spinal fractures. Twelve patients had spots of oral bleeding after ECT. Whereas 5 patients experienced mild, transient, self-limiting postictal confusion, only one had confusion which required medical termination. Five patients complained of body ache and one of memory impairment. There were no other adverse events.
The complete absence of orthopedic morbidity with benzodiazepine-modified ECT contrasts with historical descriptions of a 20% to 40% risk with unmodified ECT. We speculate that the limited muscle relaxant action of the pre-ECT parenteral benzodiazepine may have had protective effects. If so, if ECT is urgently indicated but anesthesia and hence conventional muscle relaxants cannot be administered, benzodiazepine-modified ECT may be a safer alternative to unmodified ECT. This suggestion merits wide attention because of its public health importance in countries with poor medical infrastructure, where unmodified ECT is still widely practiced.
肌肉松弛剂可降低电抽搐治疗（ECT）中的肌肉骨骼发病率，但需要在全身麻醉下使用。对于接受 ECT 治疗的患者，并非总能进行麻醉。因此，未经改良的 ECT 仍广泛应用，尤其是在发展中国家。
我们前瞻性评估了在 ECT 疗程的部分或全部过程中接受未经改良的双颞叶 ECT 的连续患者的肌肉骨骼发病率。所有患者均接受静脉注射苯二氮䓬类药物（通常为地西泮，10mg）预处理，以达到镇静、抗焦虑和有限的骨骼肌松弛作用。在最后一次未经改良的治疗后，获得了胸腰椎前后位和侧位数字 X 射线。
56 名年龄在 11 至 49 岁之间、平均体重指数为 23.0 的患者共接受了 162 次（平均 2.9 次）未经改良的 ECT。精神病理学评分显著降低。出乎我们意料的是，没有患者出现骨科发病率的临床或影像学证据；然而，在 2 名患者中，X 射线显示陈旧性脊柱骨折。12 名患者在 ECT 后出现口腔出血斑。虽然 5 名患者出现轻度、短暂、自限性的癫痫后意识模糊，但仅有 1 名患者的意识模糊需要药物干预。5 名患者诉全身酸痛，1 名患者诉记忆力减退。无其他不良事件。
与未经改良的 ECT 相关的 20%至 40%的骨科发病率的历史描述相比，苯二氮䓬类药物改良的 ECT 完全没有骨科发病率。我们推测，ECT 前的静脉用苯二氮䓬类药物的有限肌肉松弛作用可能具有保护作用。如果是这样，如果急需进行 ECT 治疗，但无法进行麻醉和常规肌肉松弛剂，则苯二氮䓬类药物改良的 ECT 可能是未经改良的 ECT 的更安全替代方案。由于在医疗基础设施薄弱的国家，未经改良的 ECT 仍广泛应用，因此这一建议具有重要的公共卫生意义，值得广泛关注。
