CHITTARANJAN ANDRADE, MD., Additional Professor, Department of Psychopharmacology, National Institute of Mental Health and Neurosciences. B.myjtore-560 029.
Indian J Psychiatry. 2000 Apr;42(2):156-62.
Official guidelines for the practice of electroconvulsive therapy (ECT) recommend routine seizure modification to minimize musculoskeletal complications; nevertheless, unmodified ECT continues to be administered in India. We therefore assessed musculoskeletal morbidity with unmodified ECT with particular reference to the development of vertebral fractures and backache X-rays of the thoracolumbar spine were routinely obtained before and after a course of 6 ECTs in 50 consecutive schizophrenic patients receiving unmodified sinusoidal wave treatment.Backache was reported by 52% of patients; the symptom was severe in 14%. Severe backache developed early during the ECT course and was commoner in older patients. Gender, height and weight did not predict either presence or severity of backache. One patient experienced a vertebral fracture which was not considered serious this contrasts with the 20-40% incidence of adverse orthopedic events described with unmodified ECT in early studies. There were no other untoward events. It is concluded that, with specific reference to Indian patients, musculoskeletal morbidity with unmodified ECT may be less than earlier believed Risks with modified vs unmodified ECT therefore need to be systematically reassessed, and decision-making processes may need to be reformulated taking individual situations into account. The findings, conclusions and recommendations of this study carry much medicolegal significance for practitioners of ECT in India.
官方指南建议对电抽搐治疗（ECT）进行常规的癫痫发作修正，以最大程度地减少肌肉骨骼并发症；然而，未经修正的 ECT 仍在印度继续使用。因此，我们评估了未经修正的 ECT 引起的肌肉骨骼发病率，特别关注了椎骨骨折和背痛的发生情况。在 50 名连续接受未经修正的正弦波治疗的精神分裂症患者中，在接受 6 个疗程的 ECT 前后，常规拍摄了胸腰椎的 X 光片。52%的患者报告有背痛；14%的患者症状严重。严重的背痛在 ECT 疗程早期出现，且在老年患者中更为常见。性别、身高和体重都不能预测背痛的存在或严重程度。一名患者经历了椎骨骨折，但被认为不严重，这与早期研究中描述的未经修正的 ECT 引起的 20-40%不良骨科事件发生率形成对比。没有其他不良事件。因此，结论是，对于未经修正的 ECT，印度患者的肌肉骨骼发病率可能低于早期研究认为的发病率。因此，需要系统地重新评估修正与未经修正的 ECT 的风险，并且需要根据个人情况重新制定决策过程。这项研究的发现、结论和建议对印度的 ECT 从业者具有重要的医疗法律意义。
