Viswanath Biju, Narayanaswamy Janardhanan C, Thirthalli Jagadisha, Gangadhar B N
National Institute of Mental Health and Neuro Sciences (NIMHANS), Bangalore, Karnataka, India.
Indian J Psychol Med. 2011 Jan;33(1):66-70. doi: 10.4103/0253-7176.85398.
Bifrontal (BF) placement of electrodes in electroconvulsive therapy (ECT) has emerged as an alternative option to the conventional bitemporal (BT) and right unilateral electrode placement in view of fewer cognitive adverse effects. However, the results have been contradictory in terms of clinical efficacy.
We studied the records of all patients referred for ECT between the months of August 2008 and July 2010 (n=1575). One hundred and five of these patients had received BF-ECT. These records were compared with the records of 105 patients who received BT-ECT. For each patient who received BF-ECT, the very next person posted for BT-ECT was taken as the control. All patients received bilateral ECTs at 1.5-times the threshold stimulus dose. The number of ECTs administered, duration of hospital stay after ECT initiation, seizure threshold and failure to achieve adequate seizures were compared. Two raters who achieved good inter-rater reliability assessed the initial severity using the clinical global impression scale and clinical improvement using a Likert scale.
The speed of response, as assessed by the number of ECTs received and the duration of hospital stay after ECT initiation was similar in the two groups. In addition, both groups were comparable in terms of clinical improvement scores on the Likert scale. BF-ECT patients also had a significantly higher seizure threshold, which remained significant in spite of controlling for age. This study is chart based, with its inherent limitations. Standard outcome measures were not used. Cognitive adverse effects were not studied.
BF-ECT performed similar to BT-ECT with regard to therapeutic efficacy. Given the consistent results of the former, with fewer cognitive side-effects, the findings of the present study support BF-ECT as the first line for electrode application.
鉴于认知不良反应较少，在电休克治疗（ECT）中采用双额叶（BF）放置电极已成为传统双颞叶（BT）和右侧单侧电极放置的替代选择。然而，在临床疗效方面结果一直存在矛盾。
我们研究了2008年8月至2010年7月期间所有转诊接受ECT治疗的患者记录（n = 1575）。其中105例患者接受了BF - ECT治疗。将这些记录与105例接受BT - ECT治疗的患者记录进行比较。对于每例接受BF - ECT治疗的患者，将紧随其后接受BT - ECT治疗的患者作为对照。所有患者均接受双侧ECT治疗，刺激剂量为阈值剂量的1.5倍。比较了ECT治疗次数、ECT开始后住院时间、癫痫阈值及未达到充分癫痫发作的情况。两名评分者使用临床总体印象量表评估初始严重程度，并使用李克特量表评估临床改善情况，二者评分者间信度良好。
两组在通过接受ECT治疗次数和ECT开始后住院时间评估的反应速度方面相似。此外，两组在李克特量表上的临床改善评分方面也具有可比性。BF - ECT患者的癫痫阈值也显著更高，即便在控制年龄后仍具有显著性。本研究基于图表，存在其固有限制。未使用标准结局指标。未研究认知不良反应。
BF - ECT在治疗效果方面与BT - ECT相似。鉴于前者结果一致且认知副作用较少，本研究结果支持将BF - ECT作为电极应用的一线选择。
