Wednesday, May 27, 2009

Electroconvulsive Therapy

I had the opportunity to observe Electro Convulsive Therapy (ECT) today. The indications for ECT are
  • major depression, resistant to medication
  • bipolar disorder
  • mania
  • schizophrenia
  • Need exists for rapid treatment response, such as in pregnancy

The relative contraindications are

  • brain tumour
  • dementia
  • delirium

ECT was performed by putting two electrodes next to your head and seizure is induced by passing electrical current through those two electrodes. You can do ECT unilateral (only one side of the head) or bilateral (two side of the head).

If you are going to do unilateral ECT, you usually choose the non-dominant hemisphere. Usually, right-handed people have their left side of the brain as their dominant hemisphere. More info on cerebral dominance.

To reduce the effects of the induced seizure, muscle relaxants need to be given eg Succinylcholine (Suxamethonium Chloride). The patient need to be under general anaesthesia and a short acting general anaesthetic agent is used. The one I saw used Propofol.

Some trivia about ECT.

  • It was initially used by Romans by using electric eels and currently ECT is no longer practised in Italy.
  • In modern age, it was initially thought that having seizure can cure schizophrenia. So, that's how ECT was started :)
  • After more than 70 years of using ECT in modern time, doctors are still not sure how ECT works inside the brain.
  • ECT is one of the last resort to treat major depression. So, once you are having ECT, it is possible that you need to have ECT for lifetime.

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