Standard ECT Research Articles

Improved Safety of Hybrid Electroconvulsive Therapy Compared With Standard Electroconvulsive Therapy in Patients With Major Depressive Disorder: A Randomized, Double-Blind, Parallel-Group Pilot Trial.

ObjectivesECT is a rapid and effective treatment for depression. While efficacy is often remarkable over the initial 3–4 sessions, the efficacy of later sessions is less rapid, and the side-effects, especially cognitive impairment limit its use. To preliminarily compare the efficacy and acceptability of a novel hybrid-ECT (HECT) protocol for patients with major depressive disorder (MDD) with standard ECT, we conducted this pilot trial.MethodsThirty patients were randomly assigned to ECT or HECT. Both arms received three ECT sessions (phase 1) but, in phase 2, the HECT arm received low-charge electrotherapy instead of ECT. The primary outcome was the change in 24-item Hamilton depression rating scale (HAMD-24) scores between baseline and the end of treatment. Cognitive function was assessed by repeatable battery for the assessment of neuropsychological status (RBANS), Stroop color word, and orientation recovery tests (ORT). Safety was measured by the drop-out rate and adverse events (AEs). Four visits were conducted at baseline, post-phase 1, post-phase 2, and at 1-month follow-up. Trial registration: Chinese Clinical Trial Registry (http://www.chictr.org.cn/), identifier: ChiCTR1900027701.ResultsPatients in both arms showed significant within-group improvements in HAMD-24, but the between-group differences were non-significant. Participants in the HECT arm outperformed ECT patients for most cognitive tests at the end of treatment or at follow-up. There was a significantly lower AE rate and shorter ORT in phase 2 of the HECT ar.ConclusionIn this pilot trial, HECT was associated with fewer AEs and better cognitive function including executive and memory function, but its possible similar antidepressive efficacy needs to be further investigated in future.

Efficacy of epirubicin plus cyclophosphamide followed by taxanes versus carboplatin plus taxanes as adjuvant chemotherapy in triple-negative breast cancer: 8.1 years median follow-up on a randomized clinical trial.

529 Background: Four cycles of adjuvant taxanes (paclitaxel or docetaxel) after four cycles of adjuvant doxorubicin plus cyclophosphamide (ECT) are considered a standard adjuvant treatment and improves survival outcomes of triple negative breast cancer (TNBC). The purpose of this analysis was to further assess whether adjuvant carboplatin plus taxanes (TP) was non-inferior to or superior to standard ECT chemotherapy in prolonging the survival time. Methods: This randomized, open-label, multicenter clinical trial conducted at three hospital in China from June, 2009 and October, 2015. Eligible early triple-negative breast cancer (TNBC) patients were randomized (1:1) to receive ECT (four cycles of epirubicin 90 mg/m2 + cyclophosphamide 600 mg/m2 followed by four cycles of docetaxel 75 mg/m2 or paclitaxel 175 mg/m2 every 3 weeks, ECT arm, n = 154) or receive TP (six cycles of docetaxel 75 mg/m2 or paclitaxel 175 mg/m2 + carboplatin AUC 5 every 3 weeks; TP arm, n = 154), which was then followed by surgery. Results: Three hundred and eight patients were recruited in this trial and final date of follow-up was January 20, 2021. Baseline characteristics were balanced between ECT arm and TP arm. Median follow-up was 97.6 months. Median disease free survival (DFS) was not reached; 8-year DFS rate was 78.35% with ECT arm and 81.73% with TP arm (hazard ratio [HR] = 0.84; 95% confidence interval [CI] = 0.50 - 1.40; P = 0.496). Median overall survival (OS) was also not reached; 8-year OS rate was 87.15% with ECT arm and 89.14% with TP arm (HR = 0.87; 95% CI = 0.44 - 1.70; P = 0.676). For TNBC patients with DFS > 4 year, TP arm had a longer DFS than ECT ( P = 0.01), and had a tendency with better OS ( P = 0.4). In this subgroup analysis of SPARC > 50%, TP arm had a longer DFS than ECT ( P < 0.05), and also had a tendency with better OS ( P = 0.06). In subgroup analysis of PD-1 (-) and intravascular invasion (+), TP arm had a better DFS ( P = 0.02) and OS ( P = 0.03) than ECT arm. DFS or OS had no significant differences in ECT and TP arm with BRCA mutation or BRCA wild ( all P values > 0.05). Conclusions: TP chemotherapy showed significant non-inferiority for PFS and OS versus ECT in the first-line adjuvant treatment of early TNBC. For some particular subgroup of TNBC, TP may be a more effective chemotherapy than ECT. TP may be considered an effective alternative to early TNBC. Clinical trial information: NCT01150513.

Magnitude of Reduction & Speed of Remission of Suicidality for Low AmPlitude Seizure Therapy (LAP-ST) Compared to Standard Right Unilateral ECT

Background: ECT is the gold standard treatment for acute suicidality and treatment resistant-depression, but concerns over cognitive side effects limit broader usage for this effective treatment. Low AmPlitude Seizure Therapy (LAP-ST) seeks to limit cognitive side effects while maintaining similar efficacy compared to standard ECT. A proof of concept LAP-ST clinical trial by Youssef et al. (2017) has shown significantly better cognitive profile of LAP-ST compared to standard Ultra-Brief Right Unilateral (UB RUL) ECT. However, the effectiveness of LAP-ST in treating suicidality is unknown. The objectives of this analysis were to: 1) Examine the safety of LAP-ST compared to RUL ECT, and 2) Compare the reduction and remission of suicidality between the two treatment groups.

S108. Speed of Remission of Suicidality for Low Amplitude Seizure Therapy (LAP-ST) Versus Right Unilateral Ultra-Brief ECT

Standard ECT is indicated in many guidelines and some studies for acute remission of suicidality. The effect of a novel form of ECT: low amplitude seizure therapy (LAP-ECT) on suicidality is unknown. The aim of this report is to: 1) Provide an interim/safety analysis of a randomized clinical trial of LAP-ST versus Right Unilateral (RUL) standard ECT (ClinicalTrials.gov ID: NCT02583490), 2) Determine the speed of remission of suicidality between the 2 study conditions.

Feasibility, safety, and preliminary efficacy of Low Amplitude Seizure Therapy (LAP-ST): A proof of concept clinical trial in man

BackgroundCurrent pulse amplitude used in clinical ECT may be higher than needed. Reducing pulse amplitude may improve focality of the electric field and thus cognitive adverse effects. Here we examine the feasibility, safety, and whether Low Pulse Amplitude Seizure Therapy (LAP-ST, 0.5–0.6A) minimizes cognitive adverse effects while retaining efficacy. MethodsPatients with treatment-resistant primary mood (depressive episodes) or psychotic disorders who were clinically indicated to undergo ECT were offered to be enrolled in an open-label study. The study consisted of a full acute course of LAP-ST under standard anesthesia and muscle relaxation. The primary outcome was feasibility of seizure induction. Clinical outcome measures were: time to reorientation (TRO), Mini Mental State Examination, Montgomery Aberg Depression Scale, and Brief Psychiatric Rating Scale, and Clinical Global Impression Scale. ResultsTwenty-two patients consented for enrollment in the study. LAP-ST was feasible, and all patients had seizures in the first session. Participants had a quick orientation with median TRO of 4.5min. Treatment was efficacious for both depressive and psychotic symptoms. LimitationsRelatively small sample size, non-blinded, and no randomization was performed in this initial proof of concept study. ConclusionsThis first human preliminary data of a full course of focal LAP-ST demonstrates that seizure induction is feasible. These results, although preliminary, suggest that the LAP-ST compared to the standard ECT techniques may result in less cognitive side effects, but comparable efficacy. Larger studies are needed to replicate these findings.

Massive Multi-Frequency Eddy Current Method for Clad Material Inspection

The aim of this paper is to present a massive multi-frequency method for detection of cracks in clad materials. A system excited by a voltage waveform obtained as a sum of many sinusoidal components is proposed for this purpose. Studies show that, the multi-frequency method can be successfully used for detection and assessment of the defects depth in such kind of materials. The experimental verification is done and selected results of measurements are presented. with a depth of changes in the tested structure. That can be useful in applications such as measuring the thickness of conductive coatings on conductive base metal, detection and identification flaws in the material surface, differentiating between flaws in various layers of built-up structure. The additional advantages is that utilization of numerous frequency components in the excitation signal allow to fully test the structure as every single frequency consists independent information. Therefore, impact of noise can be reduced. Moreover presented method is much faster than Swept Frequency Methods and can be used complementary or as a substitute for the standard ECT.

Combined local and systemic bleomycin administration in electrochemotherapy to reduce the number of treatment sessions.

BackgroundElectrochemotherapy (ECT), a medical treatment widely used in human patients for tumor treatment, increases bleomycin toxicity by 1000 fold in the treated area with an objective response rate of around 80%. Despite its high response rate, there are still 20% of cases in which the patients are not responding. This could be ascribed to the fact that bleomycin, when administered systemically, is not reaching the whole tumor mass properly because of the characteristics of tumor vascularization, in which case local administration could cover areas that are unreachable by systemic administration.Patients and methodsWe propose combined bleomycin administration, both systemic and local, using companion animals as models. We selected 22 canine patients which failed to achieve a complete response after an ECT treatment session. Eleven underwent another standard ECT session (control group), while 11 received a combined local and systemic administration of bleomycin in the second treatment session.ResultsAccording to the WHO criteria, the response rates in the combined administration group were: complete response (CR) 54% (6), partial response (PR) 36% (4), stable disease (SD) 10% (1). In the control group, these were: CR 0% (0), PR 19% (2), SD 63% (7), progressive disease (PD) 18% (2). In the combined group 91% objective responses (CR+PR) were obtained. In the control group 19% objective responses were obtained. The difference in the response rate between the treatment groups was significant (p < 0.01).ConclusionsCombined local and systemic bleomycin administration was effective in previously to ECT non responding canine patients. The results indicate that this approach could be useful and effective in specific population of patients and reduce the number of treatment sessions needed to obtain an objective response.

Efficacy of Right Unilateral Ultrabrief Pulse Width ECT

Ultrabrief (right unilateral) electroconvulsive therapy (UB-RU ECT) is a newer form of ECT, which uses a shorter pulse width than the standard ECT (0.3 vs 1.0 millisecond, respectively). As a result, the use of UB ECT may provide a means of further decreasing ECT-related cognitive adverse effects. In 2011, the University of Texas Southwestern Department of ECT in Austin adopted a UB ECT protocol. The purpose of this study was to perform a preliminary evaluation of the effectiveness and efficiency of UB-RU ECT. This study also examined whether sex, age, or diagnosis affected response rates. This retrospective chart review identified 62 patients treated with the UB ECT protocol. An analysis of ECT response rates and demographic characteristics was conducted based on the data from clinical evaluations and Patient Health Questionnaire 9. Sixty-eight percent of patients in the study responded to ECT; 55% responded to UB pulse width RU ECT with another 13% responding when switched to standard pulse width bilateral ECT. The mean number of treatments in an index ECT series was 12.5. There was no statistically significant difference in response rates between bipolar and unipolar depressed patients. Men required progression to bilateral treatment more than women. This UB ECT protocol demonstrated a similar response rate when compared to standard ECT protocols; however, an increase in the number of treatments was required. Ultrabrief protocols are a viable option for both bipolar and unipolar depression. In men, UB ECT protocols may be less advantageous due to a need to overcome a potentially higher seizure threshold in men; however, additional research is needed to confirm this finding.

Prevention of Relapse With Maintenance Electroconvulsive Therapy in Elderly Patients With Major Depressive Episode

To evaluate the effectiveness and safety of maintenance electroconvulsive therapy (mECT) in elderly patients with treatment-resistant Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition major depressive episode. Seven elderly patients with treatment-resistant major depressive episode were treated with a complete ECT cycle. Thereafter, they received one monthly ECT session as maintenance for 1 year. Response to treatment was defined as at least a 50% drop from baseline on the Hamilton Depression Rating Scale (HamD) and remission as not meeting criteria for major depression, a HamD score of 7 or less, and Clinical Global Impressions-Severity of Illness score of 1. We compared their response with the response of 7 elderly patients with treatment-resistant major depression who were treated with a full cycle of ECT but did not receive mECT (non-mECT). We compared the 2 groups for the number of relapses or recurrences of major depressive episodes after remission was achieved; a relapse or a recurrence occurred when HamD scores were 14 or higher, or when Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision major depressive episode criteria were met, or when Clinical Global Impressions-Severity of Illness score was 3 or higher and increased by at least 2 points from response/remission. The mECT group (4 women and 3 men; mean age, 73 years) had significantly less mean relapses/recurrences (0 vs 1.57) and hospitalizations (0 vs 1) and received less drug treatment than the nonMECT group (similar for age and sex composition) during the 12-month follow-up period. All patients with mECT improved during treatment and did not relapse. Maintenance ECT protected elderly patients from recurrent depressive episodes from relapsing/recurring more than standard ECT.

Does power matter with ECT?

Background To assess the incidence of depressed inpatients requiring high output ECT and the response of this group compared with a group requiring standard output ECT. Methods We reviewed the records of 59 consecutive inpatients that were treated with bilateral ECT between January 2001 and January 2004. Diagnosis of major depression was based on DSM IV criteria. Response and remission to ECT (respectively defined as a 50% reduction in score and a score of ≤ 7 on the Hamilton Rating Scale for Depression; HRSD) of both groups were compared. Results Of the 59 patients, 13 (22%) required high output ECT. These patients needed significantly more ECT treatments than patients in the standard dose group (16.4 ± 7.1 versus 10.4 ± 4.5; p = 0.01). In total, 31 of 46 patients (67%) requiring standard output ECT and 11 of the 13 patients (85%) requiring high output ECT responded to ECT. This difference is not significant. Limitations This study has a retrospective nature and a rather homogenous sample. Conclusion In this study 1 in 5 of the depressed inpatients needs a high dose energy of bilateral ECT to induce an adequate seizure. The efficacy of ECT in these patients is similar to that in the standard dose group. Considering these facts, high output ECT devices should be available for use in routine clinical practice.

The influence of rapid-rate transcranial magnetic stimulation (rTMS) parameters on rTMS effects in Porsolt's forced swimming test.

To assess the similarity of the behavioural effects of the rapid transcranial magnetic stimulation (rTMS) to those produced by other antidepressant treatments, in particular to repeated electroconvulsive shock (ECS), we carried out experiments on Wistar rats. The effects of a standard ECS procedure (9 daily treatments; the current parameters: 150 mA, 50 Hz, 0.5 s) were compared with 18 d treatment with rTMS of the same field intensity of 1.6 T but with different stimulation frequency (20 or 30 Hz) and a different number of sessions (9 or 18). Twenty-four hours after the last treatment the forced swimming test was carried out and the immobility time was recorded. The standard ECT reduced the immobility by 50%, the intensive rTMS (90 or 104 K impulses for the whole period of treatment) caused a significant effect, although smaller than that induced by ECT (reduction by 20-30%). The stimulation at 20 Hz required 18 treatment sessions to produce a significant effect, while only 9 sessions with stimulation at 30 Hz were sufficient to produce a comparable result. This suggests that the effectiveness of rTMS may be augmented by increasing the number or frequency of rTMS impulses.

虚弱下顎骨に対するカルシウム, カルシトニンの併用療法に関する光顕的ならびに超微形態的研究

After inducing bone debility in three-week-old male Wistar rats by providing calcium-deficient food, a treatment method combining standard food containing calcium and ECT (0.2 u/kg ; intramuscular injection), synthetic eel CT inducer, was used for five weeks, and the effect of the treatment was investigated. The results were as follows : I. Histopathological findings In the calcium-deficient food group, as compared with the control group, bone quantity decreased sharply ; fasciculated bone was resorbed over the whole area ; bone marrow enlarged markedly in spongy bone ; and low-calcified layers intermingled with connective tissues were seen. In the osteoid tissue, bone lacunae of irregular shapes were seen sporadically. In the calcium-deficient food plus standard food group, as compared with the calcium-deficient food group, bone remodeling was actively in progress and cementing lines were markedly seen in the transition area from bone resorption to bone formation. In the combined treatment groups, as compared with the calcium-deficient food plus standard food group, bone lacunae around the Haversian canals increased in spongy bone and so called the Haversian system was seen. Bone formation exceeded bone resorption and marked bone reconstruction was observed. The buccal and central alveolar bones adjacent to enamel organs showed active remodeling. As compared with the control group, however, many connective tissues were found in the spaces between trabeculae, and bone construction was decrased. II. In the calcium-deficient group as compared with the control group, the matrix formation surface in the whole of the alveolar bone was faveolate, and fasciculated bone, spongy bone, and cortical bone showed extensive resorption findings in the whole area. In the calcium-deficient food plus standard food group as compared with the calcium-deficient food group, the osseous layer in the whole of the alveolar bone showed active conversion of bone and the bone surface showed an increase in smooth planes. In the calcium-deficient food plus standard food plus ECT group as compared with the calcium-deficient food plus standard food group, bone construction in the whole of the osseous layer was expedited but the layer was formed thin as compared with the control group. Furthermore, bundles of collagen fibers running in a given direction were found and in the surface layer, collagen fibrils were found. On the basis of the foregoing findings, the combination therapy of Ca and CT for debilitated mandibles showed marked conversion of bone due to an increase in bone quantity and also showed clear reconstruction of bone.

Fractures of hip with manually controlled brief stimulus ECT; report of two cases.

Two cases of fracture of the neck of the femur are reported in healthy schizophrenics under 30 while using a technique of electrotherapy with a manually controlled square wave brief stimulus current, raised at intervals during the convulsion. These cases occurred in a group of 35 patients, representing an incidence of 5.7% or 0.3% of treatments, which is in marked contrast to 2 such fractures in the same hospital during the many years of standard ECT. It is suspected that the alterations in current level superimpose muscular contractions on the convulsive movements, which in certain phases of the convulsion might be particularly hazardous to the hip joint.