Shirozu Kazuhiro, Murayama Keitaro, Yamaura Ken
Department of Anesthesiology and Critical Care Medicine, Kyushu University Hospital;
Department of Neuro-Psychiatry, Kyushu University Graduate School of Medicine.
J Vis Exp. 2019 Apr 11(146). doi: 10.3791/59488.
Electroconvulsive therapy (ECT) is reported to be effective for severe neuropsychiatric disorders. In ECT, electrical stimulation is applied to the brain, inducing seizure activity. Adequate seizure induction with ECT is associated with seizure duration, symmetrical high amplitude waveforms during slow-wave activity, postictal suppression, and activation of the sympathetic nervous system. Sympathetic nervous system activation is influenced by anesthetic agents or cardiovascular drugs during ECT. Pupillary responses can reflect sympathetic nervous activity or the degree of brain damage. Pupillary response measurement can be conducted in a simple, precise, and objective way using an automated infrared pupillometer, enabling the measurement of pupil diameter (mm) to two decimal places. The white light used for measuring light reflexes is not overly bright, and patients do not typically report discomfort. Pupillary light reflexes were measured before anesthesia induction and immediately after electrical stimulation using this equipment. Pupil diameter is typically enlarged after brain damage or sympathetic nervous activation. Adequate seizure induction using ECT could induce pupillary enlargement immediately after electrical stimulation. In the current method, the constriction ratio of pupil size was calculated automatically and compared with seizure quality. Pupillary responses immediately after electrical stimulation may provide a useful assessment of the efficacy of seizure induction with ECT.
据报道，电休克疗法（ECT）对严重的神经精神疾病有效。在ECT中，将电刺激施加于大脑，诱发癫痫活动。ECT诱发足够的癫痫发作与癫痫持续时间、慢波活动期间对称的高振幅波形、发作后抑制以及交感神经系统的激活有关。ECT期间，交感神经系统的激活受麻醉剂或心血管药物的影响。瞳孔反应可以反映交感神经活动或脑损伤程度。使用自动红外瞳孔计可以以简单、精确和客观的方式进行瞳孔反应测量，能够将瞳孔直径（mm）精确到小数点后两位。用于测量光反射的白光不会过亮，患者通常也不会报告不适。使用该设备在麻醉诱导前和电刺激后立即测量瞳孔光反射。脑损伤或交感神经激活后，瞳孔直径通常会扩大。使用ECT诱发足够的癫痫发作可能会在电刺激后立即引起瞳孔扩大。在当前方法中，瞳孔大小的收缩率会自动计算并与癫痫发作质量进行比较。电刺激后立即出现的瞳孔反应可能为评估ECT诱发癫痫发作的疗效提供有用的依据。
