Shapira B, Lidsky D, Gorfine M, Lerer B
Depression Treatment Unit, Herzog Hospital, Jerusalem, Israel.
J Clin Psychiatry. 1996 Jan;57(1):32-8.
Patients with major depressive disorder (MDD) were treated with electroconvulsive therapy (ECT) to determine (1) variability of initial seizure threshold, (2) factors that influence seizure threshold, (3) change in seizure threshold during the ECT course, and (4) relationship of seizure threshold to antidepressant effects.
Seizure threshold was measured by a stimulus titration technique during the first, eighth, and final ECT of medication-free patients who had MDD, endogenous subtype based on Research Diagnostic Criteria and were randomly assigned to three-times-weekly, bilateral, brief pulse ECT (N = 24) or twice-weekly ECT plus one simulated treatment per week (N = 23). Subsequent to the first ECT, stimulus intensity was 1.3 to 1.8 (median = 1.5) times threshold. The Hamilton Rating Scale for Depression (HAM-D) was the primary clinical outcome measure.
Initial seizure threshold varied by 594%. Gender (p = .03), total strength of pre-ECT pharmacotherapy trials (p = .02), and age (p = .12) accounted for 23.9% of the variance. Threshold increased by 42% +/- 26% (p = .0001) from the first to the final ECT, and seizure duration decreased by 33% +/- 28% (p = .0001). Seizure duration and mean stimulus intensity were negatively associated over all treatments (r = -.49, p = .0003). Change in HAM-D score was related to duration of the current depressive episode (r = -.39, p = .006) and total strength of pre-ECT pharmacotherapy trials (r = -.39, p = .008), but not to seizure threshold or duration.
(1) Initial seizure threshold for pulse bilateral ECT is highly variable and not yet amenable to accurate prediction. (2) Stimulus titration allows threshold to be determined on an individual basis and dosage for subsequent treatments to be defined. (3) Seizure duration is of limited value as a sole criterion for the adequacy of treatment when initial threshold is unknown and/or electrical doses that substantially exceed threshold are used. (4) With moderately suprathreshold bilateral ECT, a relationship of seizure threshold to antidepressant response is not demonstrable.
对重度抑郁症（MDD）患者进行电休克治疗（ECT），以确定（1）初始癫痫阈值的变异性，（2）影响癫痫阈值的因素，（3）ECT疗程中癫痫阈值的变化，以及（4）癫痫阈值与抗抑郁效果的关系。
采用刺激滴定技术，对符合研究诊断标准的内源性亚型MDD、未服用药物的患者在首次、第八次和最后一次ECT治疗期间测量癫痫阈值。这些患者被随机分配至每周三次的双侧短暂脉冲ECT组（N = 24）或每周两次ECT加每周一次模拟治疗组（N = 23）。首次ECT后，刺激强度为阈值的1.3至1.8倍（中位数 = 1.5）。汉密尔顿抑郁量表（HAM-D）是主要的临床结局指标。
初始癫痫阈值变化达594%。性别（p = .03）、ECT前药物治疗试验的总强度（p = .02）和年龄（p = .12）占方差的23.9%。从首次ECT到最后一次ECT，阈值增加了42%±26%（p = .0001），癫痫持续时间减少了33%±28%（p = .0001）。在所有治疗中，癫痫持续时间与平均刺激强度呈负相关（r = -.49，p = .0003）。HAM-D评分的变化与当前抑郁发作的持续时间（r = -.39，p = .006）和ECT前药物治疗试验的总强度（r = -.39，p = .008）有关，但与癫痫阈值或持续时间无关。
（1）双侧脉冲ECT的初始癫痫阈值高度可变，尚无法准确预测。（2）刺激滴定可根据个体情况确定阈值，并确定后续治疗的剂量。（3）当初始阈值未知和/或使用大大超过阈值的电剂量时，癫痫持续时间作为治疗充分性的唯一标准价值有限。（4）对于中度超阈值双侧ECT，癫痫阈值与抗抑郁反应之间的关系无法得到证实。
