SAPBTC, Glenside Health Service, Glenside, SA, Australia.
Discipline of Psychiatry, The University of Adelaide, Adelaide, SA, Australia.
Aust N Z J Psychiatry. 2023 Sep;57(9):1202-1207. doi: 10.1177/00048674231183368. Epub 2023 Jun 23.
In the last century, prescribing electroconvulsive therapy usually involved considering the relative merits of unilateral versus bilateral electroconvulsive therapy, with most other parameters fixed. However, research over the last 30 years has discovered that several parameters of the electroconvulsive therapy stimulus can have a significant impact on efficacy and cognitive side effects. The stimulus dose relative to seizure threshold was shown to significantly affect efficacy, especially for right unilateral electroconvulsive therapy, where suprathreshold doses in the vicinity of 5-6 times seizure threshold were far more efficacious than doses closer to threshold. However, this did not hold for bitemporal electroconvulsive therapy, where near-threshold stimuli were equally effective as suprathreshold stimuli. Then, changes in stimulus pulse width were found to also have a significant impact on both efficacy and side effects, with ultrabrief pulse widths of 0.3 ms having significantly fewer cognitive side effects in unilateral electroconvulsive therapy than standard brief pulse widths of 1.0 ms, with only slightly reduced efficacy. Therefore, choosing the optimum electroconvulsive therapy prescription for an individual patient now requires consideration of placement, pulse width and stimulus dose relative to seizure threshold, and how these three interact with each other. This viewpoint aims to raise awareness of these issues for psychiatrists involved in electroconvulsive therapy practice.
在上个世纪，电抽搐治疗的处方通常涉及到单侧与双侧电抽搐治疗的相对优势的考虑，而其他大多数参数是固定的。然而，过去 30 年的研究发现，电抽搐治疗刺激的几个参数会对疗效和认知副作用产生重大影响。与癫痫发作阈值相比的刺激剂量被证明会显著影响疗效，特别是对于右侧单侧电抽搐治疗，在接近 5-6 倍癫痫发作阈值的超阈值剂量比接近阈值的剂量更为有效。然而，对于双颞叶电抽搐治疗则不然，接近阈值的刺激与超阈值刺激同样有效。然后，发现刺激脉冲宽度的变化也对疗效和副作用有显著影响，超短脉冲宽度为 0.3 毫秒的单侧电抽搐治疗比标准的 1.0 毫秒的短暂脉冲宽度的认知副作用明显更少，仅稍降低疗效。因此，现在为个体患者选择最佳的电抽搐治疗处方需要考虑放置位置、脉冲宽度和与癫痫发作阈值相比的刺激剂量，以及这三个因素如何相互作用。这一观点旨在提高参与电抽搐治疗实践的精神科医生对这些问题的认识。
