Department of Psychiatry, American University of Beirut, Beirut, Lebanon.
Brain Stimul. 2013 May;6(3):403-8. doi: 10.1016/j.brs.2013.03.004. Epub 2013 Mar 16.
Electroconvulsive therapy (ECT) remains the most effective acute treatment for severe major depression, but with significant risk of adverse cognitive effects. Unidirectional electrical stimulation with a novel electrode placement and geometry (Focal Electrically Administered Seizure Therapy (FEAST)) has been proposed as a means to initiate seizures in prefrontal cortex prior to secondary generalization. As such, it may have fewer cognitive side effects than traditional ECT. We report on its first human clinical application.
Seventeen unmedicated depressed adults (5 men; 3 bipolar disorder; age 53 ± 16 years) were recruited after being referred for ECT. Open-label FEAST was administered with a modified spECTrum 5000Q device and a traditional ECT dosing regimen until patients clinically responded. Clinical and cognitive assessments were obtained at baseline, and end of course. Time to orientation recovery, a predictor of long-term amnestic effects, was assessed at each treatment. Nonresponders to FEAST were transitioned to conventional ECT.
One patient withdrew from the study after a single titration session. After the course of FEAST (median 10 sessions), there was a 46.1 ± 35.5% improvement in Hamilton Rating Scale for Depression (HRSD24) scores compared to baseline (33.1 ± 6.8, 16.8 ± 10.9; P < 0.0001). Eight of 16 patients met response criteria (50% decrease in HRSD24) and 5/16 met remission criteria (HRSD24 ≤ 10). Patients achieved full re-orientation (4 of 5 items) in 5.5 ± 6.4 min (median = 3.6), timed from when their eyes first opened after treatment.
In this feasibility study, FEAST produced clinically meaningful antidepressant improvement, with relatively short time to reorientation. Our preliminary work first in primates and now depressed adults demonstrates that FEAST is feasible, safe, well-tolerated and, if efficacy can be optimized, has potential to replace traditional ECT.
电痉挛疗法（ECT）仍然是治疗严重重度抑郁症最有效的急性治疗方法，但存在显著的认知不良反应风险。一种新型电极放置和几何形状的单向电刺激（Focal Electrically Administered Seizure Therapy (FEAST)）已被提出作为在继发性泛化之前在前额叶皮层引发癫痫发作的一种手段。因此，它可能比传统的 ECT 具有更少的认知副作用。我们报告了其在人类临床应用中的首次尝试。
在被转介接受 ECT 治疗后，招募了 17 名未接受药物治疗的抑郁成年患者（5 名男性；3 名双相情感障碍；年龄 53 ± 16 岁）。使用改良的 spECTrum 5000Q 设备和传统的 ECT 剂量方案进行开放性 FEAST 治疗，直到患者临床反应。在基线和疗程结束时进行临床和认知评估。在每次治疗时评估定向恢复时间，这是预测长期健忘效应的指标。对 FEAST 无反应的患者转用传统 ECT。
有 1 名患者在单次滴定治疗后退出研究。在 FEAST 疗程结束后（中位数 10 次治疗），与基线相比，汉密尔顿抑郁量表 24 项评分（HRSD24）有 46.1 ± 35.5%的改善（33.1 ± 6.8，16.8 ± 10.9；P < 0.0001）。16 名患者中有 8 名符合反应标准（HRSD24 降低 50%），5 名符合缓解标准（HRSD24 ≤ 10）。患者在治疗后眼睛首次睁开后的 5.5 ± 6.4 分钟（中位数= 3.6）内实现完全定向恢复（4 项中的 5 项）。
在这项可行性研究中，FEAST 产生了有临床意义的抗抑郁改善，定向恢复时间相对较短。我们在灵长类动物和现在的抑郁成年患者中的初步工作首次表明，FEAST 是可行的、安全的、耐受良好的，如果能够优化疗效，它有可能替代传统的 ECT。
