Kemp Michael F, Allard Jacques, Pâquet Myriam, Marcotte Patrick
From the *Dr Georges L. Dumont University Hospital Centre, Vitalité Health Network, Moncton, New Brunswick, Canada; †College of Pharmacy, Dalhousie University, Halifax, Nova Scotia, Canada; ‡Department of Mathematics Statistics, University of Moncton, Moncton, New Brunswick, Canada; §Faculty of Medicine, Centre de Formation Médicale du Nouveau-Brunswick, Canada; and ∥Université de Sherbrooke, Sherbrooke, Quebec, Canada.
J ECT. 2015 Mar;31(1):37-42. doi: 10.1097/YCT.0000000000000154.
The aim of this study was to determine the safety and impact of an oral theophylline loading dose calculated to achieve a 10- to 15-mg/L plasma concentration when administered 1.5 hours before electroconvulsive therapy (ECT).
We conducted a retrospective study using inpatient hospital records between January 2007 and June 2012 at the Dr. Georges L. Dumont University Hospital Centre. Patients receiving a series of ECTs with a calculated theophylline loading dose were selected. Variables collected include ECT parameters for each ECT, medications received, and treatment-related side effects.
We identified 35 patients and analyzed 14 who had no treatment modifications except for the addition of theophylline. The mean predicted theophylline plasma concentration was 12.99 (SD, 1.09) mg/L with dosages ranging from 260 to 600 mg. Eight patients (89%) with abortive seizures and 4 (80%) with missed seizures achieved a seizure duration of greater than 15 seconds with theophylline. Seizure duration increased by 165.6% (+21.3 seconds; P = 0.048) with theophylline, and all patients (N = 5) with a maximum sustained coherence of less than 92% achieved an increase after theophylline; however, the overall increase (+8.8%, P = 0.087) was not significant. No theophylline-related adverse events were documented in 128 ECTs with theophylline, and no seizure exceeded 120 seconds.
A calculated theophylline loading dose before ECT is well tolerated and effective in prolonging seizure duration and aiding with seizure generation in patients who do not seize readily. Its positive impact in patients with lower maximum sustained coherence, in addition to the potential existence of a dose-response relationship, should be further investigated.
本研究的目的是确定在电休克治疗（ECT）前1.5小时给予口服氨茶碱负荷剂量以达到10至15mg/L血浆浓度时的安全性和影响。
我们使用2007年1月至2012年6月在乔治·L·杜蒙特大学医院中心的住院病历进行了一项回顾性研究。选择接受一系列ECT且计算了氨茶碱负荷剂量的患者。收集的变量包括每次ECT的ECT参数、接受的药物以及治疗相关的副作用。
我们确定了35例患者，并分析了14例除添加氨茶碱外未进行治疗调整的患者。预测的氨茶碱平均血浆浓度为12.99（标准差，1.09）mg/L，剂量范围为260至600mg。8例（89%）有发作中止的患者和4例（80%）有发作未出现的患者在使用氨茶碱后发作持续时间超过15秒。使用氨茶碱后发作持续时间增加了165.6%（增加21.3秒；P = 0.048），并且所有5例最大持续相干性小于92%的患者在使用氨茶碱后均有增加；然而，总体增加（+8.8%，P = 0.087）并不显著。在128次使用氨茶碱的ECT中未记录到与氨茶碱相关的不良事件，且没有发作超过120秒。
ECT前计算的氨茶碱负荷剂量耐受性良好，对于发作不易出现的患者，在延长发作持续时间和辅助发作产生方面有效。其对最大持续相干性较低的患者的积极影响，以及剂量反应关系的潜在存在，应进一步研究。
