The Principles of Electroconvulsive Therapy Based on Correlations of Schizophrenia and Epilepsy: A View From Brain Networks

Li, Qi; Li, Sha; Guo, Meng; Yang, Chongguang; Xu, Yong

doi:10.3389/fneur.2019.00688

Cited by 9 publications

(5 citation statements)

References 104 publications

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“…At the same time, however, the use of ECT continued, although in a reduced manner in comparison with the past. More recently, a renewed interest in the nature and efficiency of ECT and a significant evolution of the technologies of its application and knowledge of its mechanisms, have been significant factors in its resurgence in the Western world 12–16…”

Section: Consent To Medical Treatmentmentioning

confidence: 99%

‘Delusional’ consent in somatic treatment: the emblematic case of electroconvulsive therapy

Bersani

Pacitti

Iannitelli³

2020

J Med Ethics

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Even more than for other treatments, great importance must be given to informed consent in the case of electroconvulsive therapy (ECT). In a percentage of cases, the symbolic connotation of the treatment, even if mostly and intrinsically negative, may actually be a determining factor in the patient’s motives for giving consent. On an ethical and medicolegal level, the most critical point is that concerning consent to the treatment by a psychotic subject with a severely compromised ability to comprehend the nature and objective of the proposed therapy, but who nonetheless expresses his consent, for reasons derived from delusional thoughts. In fact, this situation necessarily brings to light the contradiction between an explicit expression of consent, a necessary formality for the commencement of therapy, and the validity of this consent, which may be severely compromised due to the patient’s inability to comprehend reality and therefore to accept the proposal of treatment, which is intrinsic to this reality. With the use of an electric current, the symbolic experience associated with anaesthesia, and the connection to convulsions, ECT enters the collective consciousness. In relation to this, ECT is symbolic of these three factors and hooks on to the thoughts, fears, feelings and expectations of delusional patients. These are often exemplified in the violent intervention of the persecutor in the patient with schizophrenia, the expected punishment for the ’error’ committed for which the depressed patient blames himself and the social repression of the maniacal patient’s affirmation of his inflated self-esteem.

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Section: Consent To Medical Treatmentmentioning

confidence: 99%

‘Delusional’ consent in somatic treatment: the emblematic case of electroconvulsive therapy

Bersani

Pacitti

Iannitelli³

2020

J Med Ethics

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“…Neural synchronization levels in left MTG, bilateral putamen/caudate, and left IPL were enhanced in patients after ECT. Left MTG and left IPL are part of the default mode network, left frontoparietal network, and central-executive network involved in attention and memory processing 45 . It is well known that ECT can temporarily impair cognitive function, particularly memory 46 .…”

Section: Discussionmentioning

confidence: 99%

“…Left MTG and left IPL are part of the default mode network, left frontoparietal network, and central-executive network involved in attention and memory processing. 45 It is well known that ECT can temporarily impair cognitive function, particularly memory. 46 The increased neural synchronization in these regions may therefore cause transient cognitive impairment after ECT.…”

Section: Residual Functional Abnormalitiesmentioning

confidence: 99%

Progressive Changes in Brain Regional Homogeneity Induced by Electroconvulsive Therapy Among Patients With Schizophrenia

Tong¹,

Dong

Guo

et al. 2022

J ECT

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Objectives: Electroconvulsive therapy (ECT) has significant effects on improving psychotic symptoms in schizophrenia (SZ), but the changes of brain function induced by it are unclear. The purpose of the study was to explore progressive ECT-induced changes in regional homogeneity (ReHo) at multiple time points before, during, and after a course of ECT. Methods:The 27 in-patients with SZ (SZ group) who met the recruitment criteria accepted clinical evaluations and resting-state functional magnetic resonance imaging scans before the first ECT (pre-ECT), after the first ECT (ECT1), and after the eighth ECT (ECT8), all conducted within 10 to 12 hours. Forty-three healthy controls (HCs; HC group) who matched well with the patients for age, sex, and years of education were recruited. For Positive and Negative Syndrome Scale (PANSS) and ReHo, progressive changes were examined. Results: Pair-wise comparisons of patient pre-ECT, ECT1, and ECT8ReHo values with HC ReHo values revealed that ECT normalized the ReHo values in bilateral superior occipital gyrus (SOG), right lingual gyrus (LG), left medial prefrontal cortex. Furthermore, improved ReHo in bilateral SOG and right LG appeared after the first ECT application. The ReHo values in right middle occipital gyrus, right middle temporal gyrus, and right inferior parietal lobule were not significantly altered by ECT. The total PANSS score was lower even after the first ECT application (mean ΔPANSS ECT1 , 11.7%; range, 2%-32.8%) and markedly reduced after the eighth application (mean ΔPANSS ECT8 , 86.3%; range, 72.5%-97.9%). Conclusions:The antipsychotic effects of ECT may be achieved through regulating synchronization of some regions such as bilateral SOG, right LG, and left medial prefrontal cortex. Furthermore, the enhanced synchronizations also take place in other regions.

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“…Summarizing, despite the growing knowledge regarding the potential mechanisms underpinning the cognitive drawbacks of ECT, there are still plenty of areas that remain uncertain. Knowing that the historical use of induced seizures for the management of psychiatric disorders was initially based on the observation of a higher number of glial cells in epileptic patients gives strength to the role of seizure in preserving glial density [53]. Considering the fact that inducing generalized seizures similar to the ones occurring in epileptic patients is essential to obtain a clinical response following ECT, recent studies propose other considerations that could also play a role in the effectiveness of said controlled convulsions, such as different stimulus intensity or electrode placement, thus implying potentially improved clinical responses.…”

Section: Discussionmentioning

confidence: 99%

The Neurobiological Basis of Cognitive Side Effects of Electroconvulsive Therapy: A Systematic Review

et al. 2021

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Decades of research have consistently demonstrated the efficacy of electroconvulsive therapy (ECT) for the treatment of major depressive disorder (MDD), but its clinical use remains somewhat restricted because of its cognitive side effects. The aim of this systematic review is to comprehensively summarize current evidence assessing potential biomarkers of ECT-related cognitive side effects. Based on our systematic search of human studies indexed in PubMed, Scopus, and Web of Knowledge, a total of 29 studies evaluating patients with MDD undergoing ECT were reviewed. Molecular biomarkers studies did not consistently identify concentration changes in plasma S-100 protein, neuron-specific enolase (NSE), or Aβ peptides significantly associated with cognitive performance after ECT. Importantly, these findings suggest that ECT-related cognitive side effects cannot be explained by mechanisms of neural cell damage. Notwithstanding, S-100b protein and Aβ40 peptide concentrations, as well as brain-derived neurotrophic factor (BDNF) polymorphisms, have been suggested as potential predictive biomarkers of cognitive dysfunction after ECT. In addition, recent advances in brain imaging have allowed us to identify ECT-induced volumetric and functional changes in several brain structures closely related to memory performance such as the hippocampus. We provide a preliminary framework to further evaluate neurobiological cognitive vulnerability profiles of patients with MDD treated with ECT.

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The Principles of Electroconvulsive Therapy Based on Correlations of Schizophrenia and Epilepsy: A View From Brain Networks

Cited by 9 publications

References 104 publications

‘Delusional’ consent in somatic treatment: the emblematic case of electroconvulsive therapy

‘Delusional’ consent in somatic treatment: the emblematic case of electroconvulsive therapy

Progressive Changes in Brain Regional Homogeneity Induced by Electroconvulsive Therapy Among Patients With Schizophrenia

The Neurobiological Basis of Cognitive Side Effects of Electroconvulsive Therapy: A Systematic Review

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