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    About: MOA Not Known, But Induction of Bilateral Generalised Seizures Required For Effects. An in

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    meilunly
    The document discusses electroconvulsive therapy (ECT). It states that while the exact mechanism is unknown, ECT is believed to work by inducing seizures which increase GABA transmission and endogenous opioids in the brain. This raises the seizure threshold and affects many neurotransmitter systems. ECT is indicated for severe major depression, mania, schizophrenia, and catatonia when other treatments are not effective. Potential side effects include cognitive effects like memory issues, as well as headaches and muscle aches. Special considerations for ECT include risks in pregnancy and for those with pacemakers. The document provides details on interpreting ECT-EEG readings and assessing efficacy versus subthreshold doses.

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    About: MOA Not Known, But Induction of Bilateral Generalised Seizures Required For Effects. An in

    Uploaded by

    meilunly
    19 views1 page
    The document discusses electroconvulsive therapy (ECT). It states that while the exact mechanism is unknown, ECT is believed to work by inducing seizures which increase GABA transmission and endogenous opioids in the brain. This raises the seizure threshold and affects many neurotransmitter systems. ECT is indicated for severe major depression, mania, schizophrenia, and catatonia when other treatments are not effective. Potential side effects include cognitive effects like memory issues, as well as headaches and muscle aches. Special considerations for ECT include risks in pregnancy and for those with pacemakers. The document provides details on interpreting ECT-EEG readings and assessing efficacy versus subthreshold doses.

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    ECT

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    The document discusses electroconvulsive therapy (ECT). It states that while the exact mechanism is unknown, ECT is believed to work by inducing seizures which increase GABA transmission and endogenous opioids in the brain. This raises the seizure threshold and affects many neurotransmitter systems. ECT is indicated for severe major depression, mania, schizophrenia, and catatonia when other treatments are not effective. Potential side effects include cognitive effects like memory issues, as well as headaches and muscle aches. Special considerations for ECT include risks in pregnancy and for those with pacemakers. The document provides details on interpreting ECT-EEG readings and assessing efficacy versus subthreshold doses.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    19 views1 page

    About: MOA Not Known, But Induction of Bilateral Generalised Seizures Required For Effects. An in

    Uploaded by

    meilunly
    The document discusses electroconvulsive therapy (ECT). It states that while the exact mechanism is unknown, ECT is believed to work by inducing seizures which increase GABA transmission and endogenous opioids in the brain. This raises the seizure threshold and affects many neurotransmitter systems. ECT is indicated for severe major depression, mania, schizophrenia, and catatonia when other treatments are not effective. Potential side effects include cognitive effects like memory issues, as well as headaches and muscle aches. Special considerations for ECT include risks in pregnancy and for those with pacemakers. The document provides details on interpreting ECT-EEG readings and assessing efficacy versus subthreshold doses.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    of 1

    ECT

    About: MOA not known, but induction of bilateral generalised seizures required for effects. An  in
    GABA transmission (depletes cortical GABA) and receptor antagonism observed – these changes raise
    seizure threshold during ECT. ECT may also lead to  of endogenous opioids which may have
    anticonvulsant properties. Nearly every neurotransmitter system is affected by ECT.

     Major depression
    Indications  Mania
     SCZ/Schizoaffective d/o

    C/I No absolute C/I – except ICP (brain tumours)

     Cognitive: retrograde + anterograde amnesia, confusion (post-ictal) or persistent


    memory disturbance
    SE/CXs
     H/A, muscle aches
     Nausea

     For pts ina cute phase of major derpession with high degree of SX severity +
    functional impairment or those w/ psychotic SXs or catatonia
    Depression
     Therapeutic response not sustained w/o continuation or maintenance TX, approx.
    90% relapse within 6 months of cessation of acute course

     For severe or TX resistant manic/mixed eps of bipolar


    Bipolar d/o
     An option for pts experienceing severe mania/depression during pregnancy

     Effective for SXs of acute SCZ but not chronic


     ECT no better than antipsychotics
    SCZ  But continuation of ECT + antipsychotics superior to antipsychotics alone
     ECT an option for pts with prominent catatonic fts. that do not respond to
    lorazepam
     Pacemakers: risk of ventricular tachycardia + fibrillation
     Pregnancy: safer during 1st trimester. Recommended in 2nd & 3rd trimester when
    Special
    medications do not control illness or when patients has HX of good results with ECT
    consideratns
     Beyond 1st trimester: risk of regurgitation is high. Thus intubation should be
    considered on case by case basis

    ECT-EEG
     Recruiting phase: low amp, fast activity
     Tonic phase: bilateral synchronouse polyspikes
     Clonic phase: high amp, polyspike, slow wave complexes that slow to 1-3Hz just before
    seizure termination
     Postictal suppression: EEG flattening, lasts approx. 90s
     Postictal phase: high amp, irregular delta waves, rhythmic theta waves progressively merge
    into pre-seizure rhythms (20-30mins after seizure termination), as number of TX, EEG
    slowing persists for longer into postictal period (returns to norm by 30days)

    Efficay – what to look for Subthreshold dose – what to look for

     Substantial delay in actual seizure onset


     Seizure onset
     Tonic reaction,  clonic movements
     Symmetry (general)
     Irregular, slow pattern w/ variable amp
     Seizure duration (20-120s)
      development of well defined slwo wave activity
     Amplitude + degree of hypersynchrony
     Brief (<15s) or prolonged (>120s) seizures
     Postictal suppression
     Poor postictal suppression (<80%)

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