Pharmacopsychiatry 2015; 48(07): 294-296
DOI: 10.1055/s-0035-1559665
Letter
© Georg Thieme Verlag KG Stuttgart · New York

A New Type of ECT Stimuli: Burst Stimulus ECT

S. S. Aksay*
1   Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Germany
,
J. M. Bumb*
1   Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Germany
,
C. Janke
2   Department of Anesthesiology and Critical Care Medicine, Medical Faculty Mannheim, Heidelberg University, Germany
,
L. Kranaster
1   Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Germany
,
A. Sartorius
1   Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Germany
› Author Affiliations
Further Information

Publication History

Publication Date:
14 August 2015 (online)

Abstract

Objectives: Pulse width in electroconvulsive therapy has significant influence on effectiveness and side effects. While shorter pulses are beneficial for cognitive performance, there is still a debate about a negative impact on ECT efficacy at least for ultra-brief pulse durations.

Methods: We report a first patient treated with burst stimulus ECT, i. e., with 4 consecutive 250-µs pulses, separated by another 250 µs. Within the same patient we compared 6 classical vs. 6 burst stimulus ECT sessions.

Results: In all cases a typical tonic-clonic seizure was observed. Seizure parameters like concordance, coherence and mid-ictal amplitude increased numerically, but not significantly with burst ECT. The time needed to show a reorientation was significantly shortened with burst stimuli (30 min vs. 14 min, p=0.007).

Conclusions: In conclusion we present the first case of ECT in a single patient comparing “classical” single stimulus pulses vs. burst stimulus ECT. The new burst stimulus was better tolerated regarding reorientation time after the treatment, while parameters of seizure quality remained basically unchanged. Whether burst stimulus ECT has the potential to improve ECT quality by reducing side effects without losing efficacy has to be investigated in clinical trials.

* Shared first authorship


 
  • References

  • 1 Cronholm B, Ottoson JO. Ultrabrief stimulus technique in electroconvulsive therapy. I. Influence on retrograde amnesia of treatments with the Elther ES electroschock apparatus, Siemens Konvulsator III and of lidocaine-modified treatment. J Nerv Ment Dis 1963; 137: 117-123
  • 2 Loo CK, Katalinic N, Smith DJ et al. A randomized controlled trial of brief and ultrabrief pulse right unilateral electroconvulsive therapy. Int J Neuropsychopharmacol 2014; 18
  • 3 Fink M. Optimizing ECT. Encephale 1994; 20: 297-302
  • 4 Verwijk E, Comijs HC, Kok RM et al. Neurocognitive effects after brief pulse and ultrabrief pulse unilateral electroconvulsive therapy for major depression: a review. J Affect Disord 2012; 140: 233-243
  • 5 Brakemeier EL, Merkl A, Wilbertz G et al. Cognitive-behavioral therapy as continuation treatment to sustain response after electroconvulsive therapy in depression: a randomized controlled trial. Biol Psychiatry 2014; 76: 194-202
  • 6 Hyrman V, Palmer LH, Cernik J et al. ECT: the search for the perfect stimulus. Biol Psychiatry 1985; 20: 634-645
  • 7 Hoyer C, Kranaster L, Janke C et al. Impact of the anesthetic agents ketamine, etomidate, thiopental, and propofol on seizure parameters and seizure quality in electroconvulsive therapy: a retrospective study. Eur Arch Psychiatry Clin Neurosci 2014; 264: 255-261
  • 8 Kranaster L, Hoyer C, Janke C et al. Bispectral index monitoring and seizure quality optimization in electroconvulsive therapy. Pharmacopsychiatry 2013; 46: 147-150
  • 9 Bundy BD, Hewer W, Andres FJ et al. Influence of anesthetic drugs and concurrent psychiatric medication on seizure adequacy during electroconvulsive therapy. J Clin Psychiatry 2010; 71: 775-777
  • 10 McCall WV, Reboussin DM, Weiner RD et al. Titrated moderately suprathreshold vs fixed high-dose right unilateral electroconvulsive therapy: acute antidepressant and cognitive effects. Arch Gen Psychiatry 2000; 57: 438-444
  • 11 Perera TD, Luber B, Nobler MS et al. Seizure expression during electroconvulsive therapy: relationships with clinical outcome and cognitive side effects. Neuropsychopharmacology 2004; 29: 813-825
  • 12 Sartorius A, Munoz-Canales EM, Krumm B et al. ECT anesthesia: the lighter the better?. Pharmacopsychiatry 2006; 39: 201-204
  • 13 Aksay SS, Bumb JM, Janke C et al. New evidence for seizure quality improvement by hyperoxia and mild hypocapnia. J ECT 2014;
  • 14 Bumb JM, Aksay SS, Janke C et al. Focus on ECT seizure quality: serum BDNF as a peripheral biomarker in depressed patients. Eur Arch Psychiatry Clin Neurosci 2015; 265: 227-232