Swartz C M
Department of Psychiatric Medicine, East Carolina University School of Medicine, Greenville, NC 27858-4354.
Neuropsychobiology. 1994;29(4):174-8. doi: 10.1159/000119083.
The development is described of a new stimulus electrode placement for electroconvulsive therapy (ECT) from expectations that relate the location and volume of induced seizure foci to side effects and efficacy, respectively. These expectations are that cognitive side effects would be minimized by avoiding induction of seizure foci in brain regions associated with neuropsychological function, and that greater efficacy would be associated with a larger volume of seizure foci. These considerations led to placement on the right temple and on the left forehead. This placement was used in an open trial on 10 consecutive female inpatients suffering from mania, depression, or mixed manic-depressive state, 9 of whom showed severe cognitive impairment, psychosis, or both. All patients achieved remission, indicating efficacy as likely above 93.3% as below it, and above 74% (p < 0.05); 6- to 10-week follow-up was essentially unchanged. No cognitive morbidity was observed. Post-ECT mini-mental status score averaged 28.4 out of 30, with an average improvement of 17.3 points, substantially better than reported after bifrontotemporal ECT. These results justify further consideration of this placement.
从将诱发性癫痫病灶的位置和范围分别与副作用及疗效相关联的预期出发，描述了一种用于电休克治疗（ECT）的新型刺激电极放置方法。这些预期是，通过避免在与神经心理功能相关的脑区诱发癫痫病灶，可将认知副作用降至最低，且癫痫病灶范围越大，疗效越好。基于这些考虑，电极被放置在右侧颞部和左侧前额。这种放置方法在一项针对10名患有躁狂症、抑郁症或混合性躁郁症的连续女性住院患者的开放试验中使用，其中9名患者存在严重认知障碍、精神病或两者皆有。所有患者均实现缓解，表明有效率可能高于或低于93.3%，且高于74%（p<0.05）；6至10周的随访结果基本未变。未观察到认知损害。ECT后简易精神状态评分平均为30分中的28.4分，平均改善17.3分，明显优于双额颞叶ECT后的报告结果。这些结果证明有必要进一步考虑这种放置方法。
