Electroconvulsive therapy and cognition: a salutary reappraisal

Kellner, Charles H.; Farber, Kate G.

doi:10.1111/acps.12658

Cited by 10 publications

(9 citation statements)

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“…Our findings offer a possible explanation for why the bitemporal ECT results in larger memory impairment than the right unilateral ECT (RUL). 11,12 These two stimulations differ as to how the electric field, 61 seizures 62 are distributed throughout the brain. The bilateral ECT leads to volume increases in both hippocampi, while after RUL, the increases are lateralized to the right hippocampus.…”

Section: Bilateral Vs Unilateral Ectmentioning

confidence: 99%

“…Secondly, both the increase of hippocampal volume and memory dysfunction follow a similar temporal trajectory, that is, both increases immediately after the ECT series 5,7,8 and return to baseline level within months. 5,9 Finally, right unilateral ECT, which mainly affects the right hippocampus, 10 is associated with fewer cognitive side effects 11,12 compared with bilateral ECT that also affects the left hippocampus. 10,13 Only three studies have assessed the relationship between changes in hippocampal volume and cognitive performance following ECT.…”

Section: Introductionmentioning

confidence: 99%

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Hippocampal volume and memory impairment after electroconvulsive therapy in patients with depression

Gbyl

Støttrup

Raghava

et al. 2021

Acta Psychiatr Scand

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Objective: Patients hesitate to consent to electroconvulsive therapy (ECT) because of the fear of memory impairment. The mechanisms underlying this impairment are unclear, but several observations suggest hippocampal alterations may be involved. We investigated whether ECT-induced change in hippocampal volume correlates with memory impairment. Methods: Using a 3 T MRI scanner, we acquired brain images and assessed cognitive performance in 22 severely depressed patients at three time points: (1) before ECT series, (2) within one week after the series, and (3) at six-month follow-up. The hippocampus was segmented into subregions using FreeSurfer. The dentate gyri (DG) were the primary regions of interest (ROIs) and major hippocampal subregions secondary ROIs. Cognitive performance was assessed using the Screen for Cognitive Impairment in Psychiatry and verbal memory using the Verbal Learning subtest. The linear mixed model and the repeated-measures correlation were used for statistical analyses. Results: ECT induced an increase in the right and left DG volume with co-occurring worsening in verbal memory, and these changes were within-patients negatively correlated (right DG, r rm = −0.85, df = 18, p = 0.0000002; left DG, r rm = −0.58, df = 18, p = 0.008). At a six-month follow-up, the volume of both DG decreased with a co-occurring improvement in verbal memory, and these changes were negatively correlated in the right DG (r rm = −0.64, df = 15, p = 0.005). Volume increases in 14 secondary ROIs were also negatively correlated with memory impairment. Conclusion: ECT-related transient increases in the volume of major hippocampal subregions within-patients are associated with memory impairment. Hippocampal alterations following ECT should be the focus in searching for causes of the cognitive side effects.

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Section: Bilateral Vs Unilateral Ectmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Hippocampal volume and memory impairment after electroconvulsive therapy in patients with depression

Gbyl

Støttrup

Raghava

et al. 2021

Acta Psychiatr Scand

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“…Informed consent documents typically include the possibility of the occurrence significant, persistent retrograde amnesia (57). For the vast majority of ECT patients, the cognitive adverse effects are a temporary nuisance and not a reason to avoid a potentially life-saving therapy (116). It should also be remembered that baseline cognitive impairment secondary to the depressed state (sometimes referred to as 'pseudodementia') resolves with successful ECT (117,118).…”

Section: Medical Risks and Adverse Effectsmentioning

confidence: 99%

When to consider electroconvulsive therapy (ECT)

Kellner

Obbels

Sienaert

2019

Acta Psychiatr Scand

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142

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When to consider electroconvulsive therapy (ECT) Kellner CH, Obbels J, Sienaert P. When to consider electroconvulsive therapy (ECT).Objective: To familiarize the reader with the role of electroconvulsive therapy (ECT) in current psychiatric medicine. Method: We review clinical indications for ECT, patient selection, contemporary ECT practice, maintenance treatment and ECT in major treatment guidelines. Results: ECT is underutilized largely due to persisting stigma and lack of knowledge about modern ECT technique. Conclusion: ECT remains a vital treatment for patients with severe mood disorders, psychotic illness and catatonia. Clinical recommendations for ECT• ECT should be prescribed earlier in the course of a severe depressive episode, not necessarily withheld until after numerous medication trials • ECT may be considered a first-line (primary) treatment for certain urgently ill patients, including those who are very suicidal, psychotic, or physically debilitated from depression Diagnostic indications for ECT • In many Western countries, severe and treatment-resistant depression is the main indication for ECT • Schizophrenia is the number one indication for ECT worldwide, but is little used for this indication in Western countries • ECT is an effective treatment for treatment-resistant mania • Delirious mania is an urgent indication for ECT • ECT is effective for treatment-resistant schizophrenia, including clozapine-resistant illness • Catatonia is very responsive to ECT • Both the motor and behavioural symptoms of Parkinson's disease respond to ECT Predictors of ECT response • Older age, psychotic symptoms, and shorter episode duration are predictors of better ECT response • Melancholic features and greater baseline depressive symptom severity are likely associated with better ECT response 304 ECT technique • Bilateral, bifrontal, and right unilateral electrode placement are all effective ECT techniques • Less urgently ill patients are often treated initially with right unilateral electrode placement • Brief and ultrabrief pulse width stimuli, now commonly used, are associated with a more benign cognitive effect profile • There is no a priori fixed number of ECT in an acute course: patients should continue treatment with ECT until they remit or a plateau has been reached, or tolerability issues require interruption of the course • Tapering of acute courses of ECT should be considered for most patients (e.g., approximately weekly treatments for several weeks past remission) • Continuation/Maintenance (C/M) ECT should be considered for patients with a history of severe, recurrent episodes who have failed to remain well on medications Additional comments • ECT is underutilized because of stigma, lack of knowledge about it, and bureaucratic restrictions • ECT is among the safest procedures performed under general anesthesia • Cognitive adverse effects are markedly decreased with modern ECT techniques, largely transient, and should not deter seriously ill patients from considering ECT.

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“…Es sollten weitere, methodisch hochwertige Studien erfolgen, um das Ausmaß und die Häufigkeit dieser Beeinträchtigungen genau zu erforschen. Zudem ist nicht mit hinreichender Sicherheit zu beurteilen, ob die von Patienten erlebten kognitiven Beeinträchtigungen tatsächlich gänzlich auf die EKT zurückzuführen sind oder ob solche Ursachenzuschreibungen durch Attributionsfehler zusätzlich verstärkt werden [58]. So könnten Patienten nach einer EKT dazu neigen, kognitive Beschwerden und Vergesslichkeit auf die Behandlung zurückzuführen, auch wenn dafür andere mögliche Ursachen, beispielsweise eine natürliche oder krankheitsbedingte Abnahme der kognitiven Leistung oder die Nebenwirkungen der medikamentösen Behandlung, ausschlaggebend sein können [58].…”

Section: Pharmakologische Faktorenunclassified

Kognitive Defizite der Elektrokonvulsionstherapie bei Depressionen: Moderierende Variablen und neuropsychologische Testverfahren

Margittai

Yardımcı

Marin

et al. 2018

Fortschr Neurol Psychiatr

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ZusammenfassungAufgrund der hohen Wirksamkeit der Elektrokonvulsionstherapie (EKT) in der leitliniengerechten Behandlung therapieresistenter depressiver Episoden und der klinischen Bedeutung kognitiver Beeinträchtigungen ist eine Optimierung des Nebenwirkungsmanagements notwendig. Da kognitive Nebenwirkungen des Verfahrens in Verbindung mit krankheitsbedingten Beeinträchtigungen das soziale Funktionsniveau und das subjektive Wohlbefinden reduzieren können, sollten eine umfassende Aufklärung und ein spezifisches Monitoring potenzieller kognitiver Nebenwirkungen erfolgen. Diese Übersichtsarbeit stellt die klinische Relevanz und die Messverfahren kognitiver Nebenwirkungen dar, die bei einer EKT-Behandlung auftreten können. Es wird diskutiert, welche patientenindividuellen, technischen und pharmakologischen Faktoren die Auswirkung der EKT auf die Kognition moderieren können. Ferner werden die Empfehlungen hinsichtlich des Monitorings kognitiver Nebenwirkungen in nationalen und internationalen Leitlinien zusammengefasst. Bei der EKT werden Beeinträchtigungen der globalen Kognition sowie anterograde und retrograde Gedächtnisstörungen beobachtet. In den ersten beiden Bereichen scheinen diese nur vorübergehend von Bedeutung zu sein, wohingegen das Ausmaß der retrograden Gedächtnisdefizite, darunter vor allem das des autobiografischen Gedächtnisses, nach aktuellem Kenntnisstand nicht klar definiert ist und potenziell länger anhaltend beeinträchtigt sein kann. Ein kontroverses Thema ist diesbezüglich auch die Frage nach geeigneten Testverfahren zur Erfassung dieser Funktionen, um die Dauer möglicher Leistungsabfälle und den Schweregrad ermitteln zu können. Im klinischen Kontext finden hierbei unterschiedliche Verfahren Verwendung, teilweise wird eine Symptomgraduierung aufgrund von Zeitmangel oder methodischer Unsicherheit nicht durchgeführt. Die vorliegenden nationalen und internationalen Leitlinien machen sehr unterschiedliche Vorgaben, wie die kognitiven Beeinträchtigungen im Laufe der Therapie beobachtet und dokumentiert werden sollen. Im deutschen Sprachraum werden keine konkreten Handlungsempfehlungen zur Erfassung von kognitiven Nebenwirkungen erteilt. In diesem Zusammenhang wird eine Überarbeitung der aktuellen Leitlinien empfohlen sowie weiterer Forschungsbedarf identifiziert, um die Erfassung und das Monitoring der Nebenwirkungen zu verbessern und Patienten mit einer erhöhten Anfälligkeit zu identifizieren.

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Electroconvulsive therapy and cognition: a salutary reappraisal

Cited by 10 publications

References 10 publications

Hippocampal volume and memory impairment after electroconvulsive therapy in patients with depression

Hippocampal volume and memory impairment after electroconvulsive therapy in patients with depression

When to consider electroconvulsive therapy (ECT)

Kognitive Defizite der Elektrokonvulsionstherapie bei Depressionen: Moderierende Variablen und neuropsychologische Testverfahren

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