Department of mood and anxiety, Institute of Mental health, Singapore 539747.
Department of mood and anxiety, Institute of Mental health, Singapore 539747; Neurostimulation Service, Institute of Mental Health, Singapore 539747; Duke-NUS Graduate Medical School, Singapore 169857.
J Affect Disord. 2021 Apr 15;285:58-62. doi: 10.1016/j.jad.2021.02.038. Epub 2021 Feb 19.
To examine the association of the anaesthesia to ECT stimulus TI (anaesthesia-ECT TI) with efficacy and cognitive outcomes after ECT treatment.
Retrospective cohort study of 690 patients who received ECT from July 2017 till December 2019. Generalized linear regression was utilized to analyse the association of mean anaesthesia-ECT TI (from session 2 to session 6 ECT treatment) with Clinical Global Impression-Severity scale (CGI-S) scores and Montreal Cognitive Assessment (MoCA) score after 6 ECT treatments, and with EEG quality during the treatments (post ictal suppression scores).
The averaged TI was 106.6±20.2 (mean±SD) seconds. There was significant improvement of overall CGI-S score after ECT treatment (3.3±1.0) vs pre-ECT treatment (5.0±0.8, p<0.001) while there was no significant change of MoCA score over the course of 6 ECT (p>0.05). The anaesthesia-ECT TI had no association with post-ECT CGI-S while longer anaesthesia-ECT TI was associated with poorer post-ECT MoCA scores [adjusted β, -0.056; 95% CI (-0.099, -0.013), p=0.011] and better EEG quality score [adjusted β (0.001), 95% CI (0, 0.002), p=0.011].
Longer TI between anaesthesia and ECT stimulus administration resulted in higher seizure quality, suggesting more effective stimulation. This was associated with more cognitive impairment but not higher efficacy. The assessment of outcomes after only 6 ECT limited the ability to fully explore associations between the TI and clinical outcomes. This was a retrospective analysis of clinical data from a real-world treatment setting. A controlled study would provide greater potential to fully explore the association between TI and clinical outcomes.
探讨麻醉至电休克刺激时间间隔（anaesthesia-ECT TI）与电休克治疗后的疗效和认知结果的关系。
这是一项回顾性队列研究，纳入了 2017 年 7 月至 2019 年 12 月期间接受电休克治疗的 690 例患者。利用广义线性回归分析从第 2 次至第 6 次电休克治疗期间平均麻醉至电休克刺激时间间隔（anaesthesia-ECT TI）与 6 次电休克治疗后临床总体印象严重程度量表（Clinical Global Impression-Severity scale，CGI-S）评分和蒙特利尔认知评估量表（Montreal Cognitive Assessment，MoCA）评分以及治疗期间脑电图质量（发作后抑制评分）的关系。
平均 TI 为 106.6±20.2（均值±标准差）秒。电休克治疗后总体 CGI-S 评分有显著改善（3.3±1.0），而治疗前为（5.0±0.8，p<0.001），但在 6 次电休克治疗过程中，MoCA 评分无显著变化（p>0.05）。麻醉至电休克刺激时间间隔与电休克后 CGI-S 评分无关，而较长的麻醉至电休克刺激时间间隔与电休克后 MoCA 评分较低相关[调整后β值，-0.056；95%置信区间（-0.099，-0.013），p=0.011]，与脑电图质量评分较高相关[调整后β值（0.001），95%置信区间（0，0.002），p=0.011]。
麻醉与电休克刺激之间较长的 TI 导致更高的癫痫发作质量，提示刺激更有效。这与认知障碍加重相关，但与疗效升高无关。仅对 6 次电休克治疗后的结果进行评估，限制了充分探索 TI 与临床结果之间关系的能力。这是对真实治疗环境下临床数据的回顾性分析。对照研究将更有潜力充分探索 TI 与临床结果之间的关系。
