Katsumura Tetsuya, Okamoto Naomichi, Tesen Hirofumi, Igata Ryohei, Ikenouchi Atsuko, Yoshimura Reiji
Department of Psychiatry, University of Occupational and Environmental Health, Kitakyushu, Fukuoka, 8078555, Japan.
Medical Center for Dementia, Hospital of University of Occupational and Environmental Health, Kitakyushu, Fukuoka, 8078555, Japan.
Int Med Case Rep J. 2022 Jul 22;15:385-387. doi: 10.2147/IMCRJ.S374983. eCollection 2022.
Numerous protocols exist to counteract prolonged seizures during modified electroconvulsive therapy (mECT), such as anaesthetic adjustments and ventilation. Evidence on methods for deciding whether to continue with the next round of mECT after a prolonged seizure and to prevent recurrent seizures is currently not well established.
The patient was a 76-year-old woman with major depressive disorder. She suffered from depressive symptoms such as decreased appetite, anxiety, and agitation. She was admitted to our hospital for mECT for the fifth time. The mECT was bilateral and started at 35% stimulus intensity, and effective convulsions were obtained for the first time. During the 8th mECT at the same intensity (35% stimulus intensity), an unexpected prolonged seizure of 966 s (over 16 minutes) occurred. The seizure was abruptly stopped with diazepam 10 mg and midazolam 2 mg. During the ninth mECT session, the stimulation intensity was increased to 50%, which resulted in effective seizures and no prolonged seizures. Subsequently, appropriate convulsions were obtained with the same stimulation intensity, and she completed 12 sessions. Her depressive symptoms improved, and she was discharged on the 45th day of hospitalization.
Prolonged seizures in mECT can be prevented by raising the stimulation intensity during the following cycle.
在改良电休克治疗（mECT）期间，存在多种应对长时间癫痫发作的方案，如麻醉调整和通气。目前，关于在长时间癫痫发作后决定是否继续下一轮mECT以及预防癫痫复发的方法的证据尚不充分。
该患者为一名76岁患有重度抑郁症的女性。她有食欲减退、焦虑和激动等抑郁症状。她第五次因mECT入院。mECT为双侧治疗，起始刺激强度为35%，首次获得有效惊厥。在第8次以相同强度（35%刺激强度）进行mECT时，意外发生了长达966秒（超过16分钟）的长时间癫痫发作。静脉注射10毫克地西泮和2毫克咪达唑仑后，癫痫发作突然停止。在第九次mECT治疗时，刺激强度增加到50%，结果产生了有效惊厥且没有长时间癫痫发作。随后，以相同刺激强度获得了适当的惊厥，她完成了12次治疗。她的抑郁症状有所改善，住院第45天出院。
在mECT中，通过在下一周期提高刺激强度可预防长时间癫痫发作。
