Nagy A Youssef1, Emad Sidhom2. 1. Department of Psychiatry and Health Behavior, Medical College of Georgia at Augusta University, 997 St. Sebastian Way, Augusta, GA 30912, USA. Electronic address: nyoussef@augusta.edu. 2. The Behman Hospital, Helwan, Cairo, Egypt; Oxford Health NHS Foundation Trust, UK.
Abstract
BACKGROUND: Current 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. METHODS: Patients 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. RESULTS: Twenty-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. LIMITATIONS: Relatively small sample size, non-blinded, and no randomization was performed in this initial proof of concept study. CONCLUSIONS: This 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.
BACKGROUND: Current 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. METHODS:Patients 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. RESULTS: Twenty-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. LIMITATIONS: Relatively small sample size, non-blinded, and no randomization was performed in this initial proof of concept study. CONCLUSIONS: This 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.
Authors: Nagy A Youssef; Dheeraj Ravilla; Cherishma Patel; Mark Yassa; Ramses Sadek; Li Fang Zhang; Laryssa McCloud; William V McCall; Peter B Rosenquist Journal: Brain Sci Date: 2019-04-29
Authors: Zhi-De Deng; Miklos Argyelan; Jeremy Miller; Davin K Quinn; Megan Lloyd; Thomas R Jones; Joel Upston; Erik Erhardt; Shawn M McClintock; Christopher C Abbott Journal: Mol Psychiatry Date: 2021-12-01 Impact factor: 13.437
Authors: Christopher C Abbott; Davin Quinn; Jeremy Miller; Enstin Ye; Sulaiman Iqbal; Megan Lloyd; Thomas R Jones; Joel Upston; Zhi De Deng; Erik Erhardt; Shawn M McClintock Journal: Am J Geriatr Psychiatry Date: 2020-06-17 Impact factor: 4.105