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Unilateral electroconvulsive therapy_in_rabbit_stroke_model1
Unilateral electroconvulsive therapy_in_rabbit_stroke_model1
Unilateral electroconvulsive therapy_in_rabbit_stroke_model1
Unilateral electroconvulsive therapy_in_rabbit_stroke_model1
Unilateral electroconvulsive therapy_in_rabbit_stroke_model1
Unilateral electroconvulsive therapy_in_rabbit_stroke_model1
Unilateral electroconvulsive therapy_in_rabbit_stroke_model1
Unilateral electroconvulsive therapy_in_rabbit_stroke_model1
Unilateral electroconvulsive therapy_in_rabbit_stroke_model1
Unilateral electroconvulsive therapy_in_rabbit_stroke_model1
Unilateral electroconvulsive therapy_in_rabbit_stroke_model1
Unilateral electroconvulsive therapy_in_rabbit_stroke_model1
Unilateral electroconvulsive therapy_in_rabbit_stroke_model1
Unilateral electroconvulsive therapy_in_rabbit_stroke_model1
Unilateral electroconvulsive therapy_in_rabbit_stroke_model1
Unilateral electroconvulsive therapy_in_rabbit_stroke_model1
Unilateral electroconvulsive therapy_in_rabbit_stroke_model1
Unilateral electroconvulsive therapy_in_rabbit_stroke_model1
Unilateral electroconvulsive therapy_in_rabbit_stroke_model1
Unilateral electroconvulsive therapy_in_rabbit_stroke_model1
Unilateral electroconvulsive therapy_in_rabbit_stroke_model1
Unilateral electroconvulsive therapy_in_rabbit_stroke_model1
Unilateral electroconvulsive therapy_in_rabbit_stroke_model1
Unilateral electroconvulsive therapy_in_rabbit_stroke_model1
Unilateral electroconvulsive therapy_in_rabbit_stroke_model1
Unilateral electroconvulsive therapy_in_rabbit_stroke_model1
Unilateral electroconvulsive therapy_in_rabbit_stroke_model1
Unilateral electroconvulsive therapy_in_rabbit_stroke_model1
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Unilateral electroconvulsive therapy_in_rabbit_stroke_model1

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  • 1. Unilateral Electroconvulsive Therapy in Rabbit Stroke Model: Evaluation Using SPECT Deepak Agrawal, NK Gowda*, R Sagar**, PK Yadav***, Departments of Neurosurgery, Nuclear medicine*, Psychiatry** & Experimental Animal Facility*** All India Institute of Medical Sciences, New Delhi, India-110029
  • 2. Background
    • rCBF Increases following induced seizure
    • Sestoft D, Meden P, Hemmingsen R, et al: Disparity in regional cerebral blood flow during electrically induced seizure. Acta Psychiatr Scand 1993;88:140-143.
  • 3. Hypothesis
    • This increase in rCBF may have a positive effect on the infarct size following stroke
  • 4. AIMS & OBJECTIVES
    • To evaluate the efficacy of unilateral electroconvulsive therapy (UECT) for cerebral protection following induced stroke in rabbits
  • 5. Why Rabbit Model
    • Vascular supply & distribution mimics human brain
    • Induced strokes are more representative of humans
  • 6. Why UECT?
    • ECT has been previously shown to improve rCBF
    • UECT causes marked improvement in CBF in the ipsilateral hemisphere
    • B/L ECT improves perfusion in striatum
    • Devanand DP, Dwork AJ, Hutchinson ER, Bolwig TG, Sackeim HA: Does ECT alter brain structure? Am J Psychiatry 1994;151:957-970 .
  • 7. Materials & Methods
    • Prospective randomized controlled study
    • Randomization: computer generated random number method
    • Approval was taken from the institutional ethics committee for animal experiments.
  • 8. Materials & Methods
    • RABBITS
    • New Zealand strain
    • Weight- 2-3 kg
    • Both Male and female animals were used
  • 9. Materials & Methods
    • Anesthesia
    • Pre-anesthetized by 10% ketamine (20 mg/kg) given IM
    • Continuous infusion of midazolam 0.2mg/kg and ketamine (0.2 ml/ kg/hour).
    • 2ml of 0.5% lignocaine was infiltrated S/C
  • 10. Materials & methods
    • Operative Procedure
    • Femoral cut down for IV access
    • 2cm long incision along ant border of SCM
    • Using blunt dissection CCA exposed
    • ICA identified & ligated with silk.
    • Wound closed
  • 11. Materials & Methods
    • 2 mCi of Tc-99m HMPAO (Amersham, England) was then injected into the femoral vein, 10 minutes after induced stroke (carotid ligature).
  • 12. Materials & Methods
    • Animal transported to nuclear medicine on a modified trolley, on ventimask and IV.
    • Planar and SPECT images of the brain were taken 50 minutes after stroke.
  • 13. Materials & Methods
    • UECT Group rabbits
    • Unilateral Rt ECT was given 75 minutes after the induced stroke.
  • 14. Materials & Methods
    • ECT Procedure
    • Modified Thymatron (TM) DGx, (Somatics LLC, Lake Bluff, IL, USA) ECT machine
    • A brief-pulse square wave (0.5ms) & constant current of 0.9 A.
    • Stimulus kept at 10% with impedence (resistance) of 800 ohms
    • Induced seizure was considered adequate when its duration > 20 sec.
  • 15. Materials & Methods
    • CONTROL RABBITS
    • NO UECT
  • 16. Materials & Methods
    • Both groups received 6 mCi of Tc-99m HMPAO after 90 minutes of stroke.
    • A second set of planar and SPECT images were taken 150 minutes after stroke.
  • 17. Materials & Methods
    • Relative uptake of the radiotracer in both groups of rabbits was displayed on computer monitor and was analyzed using a graded grey scale.
    • Cerebellum was used as reference site (100% maximum value) for all comparisons
  • 18. Materials & Methods
    • Rabbits sacrificed using high dose of pancuronium and thiopentone given IV.
  • 19. STUDY DESIGN 5 RABBITS Rt ICA LIGATION SPECT Brain (50 min after stoke) Randomised to UECT Gp (n=3) Randomised to Control Gp (n=2) Rt Sided UECT No ECT REPEAT SPECT (120 min after stroke) ANIMAL SACRIFIED
  • 20. RESULTS
    • Study terminated prematurely as Ethics committee withdrew approval after 5 rabbits.
    • UECT Group – 3 Rabbits
    • Control Group- 2 Rabbits
  • 21. RESULTS
    • The right cerebrum showed decrease uptake of radiotracer compared to left cerebrum in all five rabbits confirming induction of ischemia.
  • 22. RESULTS
    • UECT Group
    • There was improvement in the regional cerebral blood flow on the affected side in all three rabbits
  • 23. UECT GROUP PRE-UECT POST-UECT
  • 24. RESULTS
    • Control group
    • No control group rabbit showed any improvement in cerebral perfusion on delayed SPECT.
  • 25. LIMITATIONS
    • No of rabbits studied was small
    • Embolic stroke model would have been preferred to carotid ligation
    • PET would have been better in imaging the induced stroke
  • 26. CONCLUSIONS
    • All rabbits receiving UECT had improvement in cerebral perfusion following induced stroke, vis-à-vis the control group.
  • 27. CONCLUSIONS
    • This study shows that UECT decreases the infarct size and increases rCBF in rabbit stroke model.
    • Further studies using a larger sample size will be required for confirmation.
  • 28. Thank You

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