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Electro Convulsive Therapy
Electro Convulsive Therapy
Electro Convulsive Therapy
Electro Convulsive Therapy
Electro Convulsive Therapy
Electro Convulsive Therapy
Electro Convulsive Therapy
Electro Convulsive Therapy
Electro Convulsive Therapy
Electro Convulsive Therapy
Electro Convulsive Therapy
Electro Convulsive Therapy
Electro Convulsive Therapy
Electro Convulsive Therapy
Electro Convulsive Therapy
Electro Convulsive Therapy
Electro Convulsive Therapy
Electro Convulsive Therapy
Electro Convulsive Therapy
Electro Convulsive Therapy
Electro Convulsive Therapy
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Electro Convulsive Therapy

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Presentation on ECT. …

Presentation on ECT.
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  • 1. ECT Dr.D.Raj Kiran.
  • 2. What is ECT • ECT- Application of electric current to the head with the aim of inducing a controlled tonic-clonic seizure, usually at regular intervals, to achieve an improvement in an abnormal mental state. • Modified ECT- Induction of cerebral seizure under anaesthesia. • Unmodified ECT- Induction of cerebral seizure without anaesthesia.
  • 3. History • In 16th century, the Swiss alchemist Paracelsus gave camphor by mouth to induce convulsions and “cure lunacy.” • In 18th & 19th century, several cases of convulsions induced by chemical means were documented.
  • 4. History • Manfred Sakel was the developer of insulin shock therapy. • He noted that insulininduced coma and convulsions had a change in the mental state of drug addicts and psychotics. • Complications were high.
  • 5. History • In 1934, Lazlo Meduna, a Hungarian psychiatrist, injected camphor in oil into a catatonic schizophrenia, causing grand mal seizure. • After series of such treatments pts recovered. • Later Camphor was replaced by pentylenetetrazol.
  • 6. History • Pentylenetetrazol caused lot of unpleasant sensations. • The concept of applying electricity was developed. • Swiss scientists induced seizures in dogs using direct electrical current.
  • 7. Birth of ECT • Italian scientists, Cerletti and Bini subsequently succeeded in applying electricity directly to the human scalp. • In 1938, they treated an unidentified 39-year-old man who was found delusional in a train station. • He recovered fully after 11 treatments without adverse Effects.
  • 8. Birth of ECT Ugo Cerletti Cerletti’s ECT machine
  • 9. Effects of ECT • During ECT, brain imaging showsHypermetabolic state – increases in cerebral blood flow (CBF). – increase cerebral metabolic rate (CMR). • Post-ictal state- functional suppression – decreases in CBF. – decrease in CMR. • Also during & after ECT, there are δ waves indicating reduction in neural activity.
  • 10. Mechanism of action • No “definitive theory” regarding the mechanisms of action. • Psychological theories- patient expectation, placebo effects, forced regression, and contribution of retrograde amnesia to clinical response. • These were proved to be incorrect.
  • 11. Mechanism of action • Biological theories- they are related to ECT's anticonvulsant effects. • These effects manifest during a course of ECT. • They include – – – – progressive increases in seizure threshold. progressive decrease in seizure duration. increases in inhibitory neurotransmitters. decreases in excitatory neurotransmitters.
  • 12. Mechanism of action • Recent studies– Transient induction of increased proinflammatory cytokines, – Increased expression of brain-derived neurotrophic factor (BDNF), – Gene polymorphism, – Enhanced activity in the GABAergic, glutaminergic and dopaminergic systems, – Enhance neurogenesis, synaptogenesis and remodelling of synapses in hippocampus.
  • 13. Electrical principles • Waveforms – Sine wave- more cognitive deficits – Brief square wave- better efficacy & less adverse effects. • An adequate seizure is defined as – – – – Motor seizure > 25 sec. EEG seizure of 30-120 sec. Rise of HR by > 50% during seizure. Post-ictal rise in PRL.
  • 14. Electrode placement Bilateral Unilateral • Electrodes are placed apart over each hemisphere. • More rapid therapeutic response. • Mc- Bitemporal, Bifrontal. • Both electrodes placed apart over non dominant hemisphere. • Less marked cognitive deficits. • Mc- Right unilateral.
  • 15. Electrode placement • Bilateral- electrode is placed 2.5 -4cm above the midpoint of line joining tragus & lateral canthus. • Unilateral- another electrode at vertex.
  • 16. Indications • • • • • • • • • • Major depression. Mania. Schizophrenia. Catatonia. Parkinson’s disease. Intractable seizures. Delirium. Gilles de la tourette syndrome. Hallucinogen induced psychosis. Neuroleptic malignant syndrome (NMS).
  • 17. Contra-indications • Absolute- “none” • Relative– – – – – – – – Space occupying intracranial lesion. Raised ICP. Recent MI with unstable cardiac function. Vascular aneurysm. Recent Intra cranial hemorrhage. Retinal detachment. Pheochromocytoma. Anesthesia risk. • Pregnancy is not a contraindication.
  • 18. Pretreatment • Informed consent • Evaluation– History & Examination. – Medical evaluation- systemic examination, fundus, ECG, electrolytes. – Anaesthetic evaluation. • Bite block • Anaesthetic agents- thiopental/propofol, muscle relaxant (SCh), anticholinergics.
  • 19. Adverse effects • Nausea, vomiting, headache. • CNS– Post-ictal confusion. – Memory problems- retrograde > anterograde. • Fractures & Muscle injuries- direct ECT. • Death- 1 in 25,000. causes could be MI, Ventricular arrhythmias, respiratory complications.
  • 20. Video…. • Video on Modified ECT

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