Noninvasive Neuromodulation Unit, Experimental Therapeutics and Pathophysiology Branch, National Institute of Mental Health, Bethesda, MD, USA.
Neuropsychopharmacology. 2024 Jan;49(1):150-162. doi: 10.1038/s41386-023-01677-2. Epub 2023 Jul 24.
We have known for nearly a century that triggering seizures can treat serious mental illness, but what we do not know is why. Electroconvulsive Therapy (ECT) works faster and better than conventional pharmacological interventions; however, those benefits come with a burden of side effects, most notably memory loss. Disentangling the mechanisms by which ECT exerts rapid therapeutic benefit from the mechanisms driving adverse effects could enable the development of the next generation of seizure therapies that lack the downside of ECT. The latest research suggests that this goal may be attainable because modifications of ECT technique have already yielded improvements in cognitive outcomes without sacrificing efficacy. These modifications involve changes in how the electricity is administered (both where in the brain, and how much), which in turn impacts the characteristics of the resulting seizure. What we do not completely understand is whether it is the changes in the applied electricity, or in the resulting seizure, or both, that are responsible for improved safety. Answering this question may be key to developing the next generation of seizure therapies that lack these adverse side effects, and ushering in novel interventions that are better, faster, and safer than ECT.
我们已经了解近一个世纪了，诱发癫痫发作可以治疗严重的精神疾病，但我们不知道的是原因是什么。电休克疗法（ECT）比传统的药物干预起效更快、效果更好；然而，这些益处伴随着副作用的负担，最明显的是记忆力丧失。阐明 ECT 发挥快速治疗益处的机制与导致不良反应的机制，可以开发出新一代没有 ECT 弊端的癫痫治疗方法。最新的研究表明，这一目标可能是可以实现的，因为 ECT 技术的改进已经在不影响疗效的情况下改善了认知结果。这些改进涉及到电的施加方式（大脑中的位置和施加的电量）的变化，这反过来又会影响到产生的癫痫的特征。我们不完全理解的是，是施加的电流的变化，还是产生的癫痫，或者两者都对提高安全性负责。回答这个问题可能是开发新一代没有这些不良反应的癫痫治疗方法的关键，同时也为更好、更快、更安全的新型干预措施铺平了道路。
