Micoulaud-Franchi J-A, Quilès C, Cermolacce M, Belzeaux R, Adida M, Fakra E, Azorin J-M
Service d'explorations fonctionnelles du système nerveux, Clinique du sommeil, CHU de Bordeaux, Place Amélie Raba-Léon, 33076 Bordeaux, France.
Unité d'électroconvulsivothérapie, CH Charles Perrens, 33000 Bordeaux, France.
Encephale. 2016 Dec;42(6S):S51-S59. doi: 10.1016/S0013-7006(17)30055-6.
The first objective of this article is to summarize the history of electroconvulsive therapy (ECT) in psychiatry in order to highlight the transition from clinical level of evidence based on phenomenological descriptions to controlled trial establishing causal relationship. The second objective is to apply the criteria of causation for ECT, to focus on the dose-effect relationship criteria, and thus to analyze the conditions of application of these criteria for ECT.
A literature review exploring the use of electricity, ECT and electroencephalography (EEG) in psychiatry was conducted. The publications were identified from the Pubmed and GoogleScholar electronic databases. The scientific literature search of international articles was performed in July 2016.
In 1784, a Royal commission established in France by King Louis XVI tested Mesmer's claims concerning animal magnetism. By doing that, the commission, including such prominent scientists as the chemist Anton Lavoisier and the scientist and researcher on electricity and therapeutics Benjamin Franklin, played a central role in establishing the criteria needed to assess the level of evidence of electrical therapeutics in psychiatry. Surprisingly, it is possible to identify the classical Bradford Hill criteria of causation in the report of the commission, except the dose-effect relationship criteria. Since then, it has been conducted blinded randomized controlled trials that confirmed the effectiveness of ECT against ECT placebos for the treatment of psychiatric disorders. At present, the dose-effect relationship criteria can be analyzed through an EEG quality assessment of ECT-induced seizures.
EEG quality assessment includes several indices: TSLOW (time to onset of seizure activity ≤5Hz, seconds), peak mid-ictal amplitude (mm), regularity (intensity or morphology of the seizure (0-6)), stereotypy (global seizure patterning, 0-3) and post-ictal suppression (0-3). A manual rating sheet is needed to score theses indices. Such manual rating with example of EEG segments recording is proposed in this article. Additional studies are needed to validate this manual, to better establish the dose-response relationship for the ECT, and thus strengthen the position of the EEG as a central element for clinical good practice for ECT.
本文的首要目的是总结精神病学中电休克治疗（ECT）的历史，以突出从基于现象学描述的临床证据水平向建立因果关系的对照试验的转变。第二个目的是应用ECT的因果标准，关注剂量效应关系标准，从而分析这些标准在ECT中的应用条件。
进行了一项文献综述，探讨电、ECT和脑电图（EEG）在精神病学中的应用。这些出版物是从PubMed和Google Scholar电子数据库中识别出来的。2016年7月进行了国际文章的科学文献检索。
1784年，路易十六国王在法国成立了一个皇家委员会，对梅斯梅尔关于动物磁性的说法进行测试。通过这样做，该委员会，包括化学家安托万·拉瓦锡等杰出科学家以及电学和治疗学科学家兼研究员本杰明·富兰克林，在确立评估精神病学中电疗法证据水平所需的标准方面发挥了核心作用。令人惊讶的是，除了剂量效应关系标准外，在该委员会的报告中可以识别出经典的布拉德福德·希尔因果标准。从那时起，已经进行了双盲随机对照试验，证实了ECT相对于ECT安慰剂治疗精神疾病的有效性。目前，可以通过对ECT诱发癫痫发作的脑电图质量评估来分析剂量效应关系标准。
脑电图质量评估包括几个指标：TSLOW（癫痫发作活动开始时间≤5Hz，秒）、发作中期峰值幅度（毫米）、规律性（癫痫发作的强度或形态（0 - 6））、刻板性（整体癫痫发作模式，0 - 3）和发作后抑制（0 - 3）。需要一份手动评分表来对这些指标进行评分。本文提出了带有脑电图片段记录示例的这种手动评分方法。需要进一步的研究来验证这份手册，以更好地确立ECT的剂量反应关系，从而加强脑电图作为ECT临床良好实践核心要素的地位。
