Abhishekh Hulegar A, Thirthalli Jagadisha, Hegde Anusha, Phutane Vivek H, Kumar Channaveerachari N, Muralidharan Kesavan, Gangadhar Bangalore N
Medical Student, Bangalore Medical College and Research Institute, Bangalore, Karnataka, India.
Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India.
Indian J Psychol Med. 2014 Jan;36(1):45-7. doi: 10.4103/0253-7176.127248.
Mechanism of action of electroconvulsive therapy (ECT) is unclear. Anticonvulsant action of ECT has also been one among the hypothesized mechanisms. Anticonvulsant effect may manifest during ECT in at least two ways (a) increased seizure threshold (b) decrease in seizure duration. In depression, increased seizure threshold has been shown to be associated with better antidepressant response. However, relationship between seizure duration and antidepressant activity has been inconsistent. These issues are not investigated in conditions other than depression.
We examined seizure duration over the course of ECT in schizophrenia patients.
Material for this analysis was obtained from a clinical trial examining the differential efficacy of bifrontal ECT (BFECT) versus bitemporal ECT (BTECT) in schizophrenia patients. As a part of study 122 schizophrenia patients who were prescribed ECT were randomized to receive either BFECT or BTECT.
Final analysis was conducted on data from 70 patients, as the rest of the data either had artifact or there was a significant change in medication status. Electroencephalogram seizure duration was noted in each session for these patients.
Seizure duration declined significantly from second ECT to 6(th) ECT (repeated measures analysis of variance F = 4.255; P = 0.006). When separate analysis was conducted for BTECT and BFECT patients the decline in seizure duration from 2(nd) to 6(th) ECT was significant only with BFECT (F = 3.94; P = 0.014) and not with BTECT (F = 0.966; P = 0.424).
Better anticonvulsant effects with BFECT may explain the better therapeutic observed with BFECT in schizophrenia as well as mania in our earlier studies.
电休克治疗（ECT）的作用机制尚不清楚。ECT的抗惊厥作用也是其中一个被假设的机制。抗惊厥作用可能在ECT期间至少以两种方式表现出来：（a）癫痫发作阈值升高；（b）癫痫发作持续时间缩短。在抑郁症中，癫痫发作阈值升高已被证明与更好的抗抑郁反应相关。然而，癫痫发作持续时间与抗抑郁活性之间的关系并不一致。这些问题在抑郁症以外的疾病中尚未得到研究。
我们研究了精神分裂症患者在ECT过程中的癫痫发作持续时间。
该分析的材料来自一项临床试验，该试验研究了双额叶ECT（BFECT）与双颞叶ECT（BTECT）在精神分裂症患者中的疗效差异。作为研究的一部分，122名接受ECT治疗的精神分裂症患者被随机分为接受BFECT或BTECT。
对70名患者的数据进行最终分析，因为其余数据要么存在伪迹，要么用药状态有显著变化。记录了这些患者每次ECT治疗时的脑电图癫痫发作持续时间。
癫痫发作持续时间从第二次ECT到第六次ECT显著下降（重复测量方差分析F = 4.255；P = 0.006）。当对BTECT和BFECT患者进行单独分析时，癫痫发作持续时间从第二次到第六次ECT的下降仅在BFECT组显著（F = 3.94；P = 0.014），而在BTECT组不显著（F = 0.966；P = 0.424）。
BFECT更好的抗惊厥作用可能解释了在我们早期研究中观察到的BFECT在精神分裂症以及躁狂症中更好的治疗效果。
