Thörnblom Elin, Gingnell Malin, Cunningham Janet L, Landén Mikael, Bodén Robert
Department of Medical Sciences, Psychiatry, Uppsala University, Uppsala, Sweden.
Institute of Neuroscience and Physiology, Sahlgrenska academy at University of Gothenburg, Gothenburg, Sweden.
Nord J Psychiatry. 2023 Apr;77(3):312-318. doi: 10.1080/08039488.2022.2107237. Epub 2022 Aug 15.
Physiological parameters that predict electroconvulsive therapy (ECT) effectiveness may reflect propagation of the induced epileptic seizure. As an indication of seizure propagation to the diencephalon, we here examined the correlation between prolactin increase after ECT and clinical seizure evaluation parameters, focusing on peak heart rate. As a proxy for peripheral endocrine stress response, we examined the correlation to postictal cortisol increase.
Participants were consecutively recruited from clinical ECT patients ( = 131, age 18-85 years). The first ECT session in a series was examined. For each participant, blood serum concentrations of prolactin and cortisol were measured immediately before and within 30 min after the seizure. Physiological parameters were extracted from clinical records: peak heart rate (HR) during seizure, electroencephalography (EEG) seizure duration, and motor seizure duration. Correlations were calculated using non-parametric tests.
Serum prolactin increased after ECT and correlated with peak HR, EEG seizure duration, and motor seizure duration. Peak HR during seizure also correlated positively with both EEG seizure duration and motor seizure duration. Correlations were unaffected by age, sex, baseline prolactin levels, antipsychotics, or beta-blocking agents. Serum cortisol increased after ECT but did not correlate with the seizure evaluation parameters, nor with prolactin concentrations.
Our findings of a positive correlation between peak HR and prolactin that was independent from the peripheral endocrine stress response might be in line with the idea that tachycardia during ECT seizures reflects seizure propagation to the diencephalon. This supports the practice of monitoring cardiovascular response for ECT seizure evaluation.
预测电休克治疗（ECT）效果的生理参数可能反映诱发癫痫发作的传播情况。作为癫痫发作传播至间脑的一个指标，我们在此研究ECT后催乳素升高与临床癫痫发作评估参数之间的相关性，重点关注心率峰值。作为外周内分泌应激反应的替代指标，我们研究了其与发作后皮质醇升高的相关性。
连续招募临床ECT患者（n = 131，年龄18 - 85岁）。检查系列中的首次ECT治疗。对每位参与者，在癫痫发作前及发作后30分钟内测量血清催乳素和皮质醇浓度。从临床记录中提取生理参数：癫痫发作时的心率峰值（HR）、脑电图（EEG）癫痫发作持续时间和运动性癫痫发作持续时间。使用非参数检验计算相关性。
ECT后血清催乳素升高，并与心率峰值、EEG癫痫发作持续时间和运动性癫痫发作持续时间相关。癫痫发作时的心率峰值也与EEG癫痫发作持续时间和运动性癫痫发作持续时间呈正相关。相关性不受年龄、性别、基线催乳素水平、抗精神病药物或β受体阻滞剂的影响。ECT后血清皮质醇升高，但与癫痫发作评估参数及催乳素浓度均无相关性。
我们发现心率峰值与催乳素之间存在正相关，且独立于外周内分泌应激反应，这可能与ECT癫痫发作期间的心动过速反映癫痫发作传播至间脑的观点一致。这支持了在ECT癫痫发作评估中监测心血管反应的做法。
