Department of Psychiatry & Health Behavior, Medical College of Georgia at Augusta University, Augusta, GA.
Departments of Psychiatry and Radiology, Columbia University, New York, NY.
J ECT. 2021 Jun 1;37(2):133-139. doi: 10.1097/YCT.0000000000000737.
Seventy percent of patients with treatment-resistant schizophrenia do not respond to clozapine. Electroconvulsive therapy (ECT) can potentially offer significant benefit in clozapine-resistant patients. However, cognitive side effects can occur with ECT and are a function of stimulus parameters and electrode placements. Thus, the objective of this article is to systematically review published clinical trials related to the effect of ECT stimulus parameters and electrode placements on cognitive side effects. We performed a systematic review of the literature up to July of 2020 for clinical studies published in English or German examining the effect of ECT stimulus parameters and/or electrode placement on cognitive side effects in patients with schizophrenia or schizoaffective disorder. The literature search generated 3 randomized, double-blind, clinical trials, 1 randomized, nonblinded trial, and 1 retrospective study. There are mixed findings regarding whether pulse width and stimulus dose impact on cognitive side effects. One study showed less cognitive side effect for right unilateral (RUL) than bitemporal (BT) electrode placement, and 2 studies showed a cognitive advantage for bifrontal (BF) compared with BT ECT. Only 1 retrospective study measured global cognition and showed post-ECT cognitive improvement with all treatment modalities using Montreal Cognitive Assessment in comparison to pre-ECT Montreal Cognitive Assessment scores. Current data are limited, but evolving. The evidence suggests that RUL or BF ECT have more favorable cognitive outcomes than BT ECT. Definitive larger clinical trials are needed to optimize parameter and electrode placement selection to minimize adverse cognitive effects.
70%的治疗抵抗性精神分裂症患者对氯氮平没有反应。电休克疗法 (ECT) 可能会给氯氮平抵抗的患者带来显著的益处。然而，ECT 可能会产生认知副作用，且副作用的发生与刺激参数和电极放置有关。因此，本文的目的是系统地回顾与 ECT 刺激参数和电极放置对认知副作用的影响相关的已发表的临床试验。
我们对截至 2020 年 7 月发表的英文或德文的研究进行了系统的文献回顾，这些研究检查了 ECT 刺激参数和/或电极放置对精神分裂症或分裂情感障碍患者认知副作用的影响。文献检索产生了 3 项随机、双盲、临床试验、1 项随机、非盲试验和 1 项回顾性研究。关于脉冲宽度和刺激剂量是否会影响认知副作用，存在混合的发现。一项研究表明，右侧单侧（RUL）电极放置比双颞部（BT）电极放置的认知副作用更小，两项研究表明，与 BT ECT 相比，双额部（BF）ECT 具有认知优势。只有一项回顾性研究测量了整体认知，并且与 ECT 前的蒙特利尔认知评估分数相比，使用蒙特利尔认知评估，所有治疗方式都显示出 ECT 后认知改善。
目前的数据有限，但正在不断发展。证据表明，RUL 或 BF ECT 比 BT ECT 具有更好的认知结果。需要进行更大规模的临床试验来优化参数和电极放置选择，以最大程度地减少认知不良反应。
