Electric Treatment

Biomedical Engineering

Electric Treatment "Electroconvulsive

therapy (ECT)"
Introduction
Electroconvulsive therapy (ECT), formerly known as electroshock
therapy and often referred to as shock treatment, is a
psychiatric treatment in which seizures are electrically induced in
patients to provide relief from psychiatric illnesses. The ECT procedure
was first conducted in 1938 and is the only currently used form of shock
therapy in psychiatry. ECT is often used with informed as a last line of
intervention for major depressive disorder, mania and catatonia. ECT
machines have been placed in the Class III category (high risk) by the
FDA since 1976.
A round of ECT is effective for about 50% of people with treatmentresistant major depressive disorder, whether it is unipolar or bipolar.
Follow-up treatment is still poorly studied, but about half of people who
respond relapse within 12 months. Aside from effects in the brain, the
general physical risks of ECT are similar to those of brief general
anesthesia. Immediately following treatment, the most common adverse
effects are confusion and memory loss. ECT is considered one of the
least harmful treatment options available for severely depressed
pregnant women.

How is it performed
Prior to ECT treatment, a patient is given a muscle relaxant and is put to
sleep with a general anesthesia. Electrodes are placed on the patient's
scalp and a finely controlled electric current is applied. This current
causes a brief seizure in the brain.
Because the muscles are relaxed, the visible effects of the seizure will
usually be limited to slight movement of the hands and feet. Patients are
carefully monitored during the treatment. The patient awakens minutes
later, does not remember the treatment or events surrounding it, and is
often confused. The confusion typically lasts for only a short period of
time.
ECT is usually given up to three times a week for a total of two to four
weeks.

 Who Might Benefit From ECT

According to the American Psychiatric Association, ECT can be beneficial
and safe in the following situations:

When a need exists for rapid treatment response, such as in pregnancy

When a patient refuses food and that leads to nutritional deficiencies
When a patient's depression is resistant to antidepressant therapy
When other medical ailments prevent the use of antidepressant
medication
When treating bipolar disorder, including both mania and depression
When treating mania
When treating patients who have a severe risk of suicide
When treating patients who have had a previous response to ECT
When treating patients with major depression
When treating schizophrenia

Technique
In unilateral ECT, both electrodes are placed on the same side of the
patient's head. Unilateral ECT may be used first to minimize side effects
(memory loss). When electrodes are placed on both sides of the head,
this is known as bilateral ECT. In bifrontal ECT, an uncommon variation,
the electrode position is somewhere between bilateral and unilateral.
Unilateral is thought to cause fewer cognitive effects than bilateral but is
considered less effective if the dose administered is close to the seizure
threshold.
The electrodes deliver an electrical stimulus. The stimulus levels
recommended for ECT are in excess of an individual's seizure threshold:
about one and a half times seizure threshold for bilateral ECT and up to
12 times for unilateral ECT. Below these levels treatment may not be
effective in spite of a seizure, while doses massively above threshold
level, especially with bilateral ECT, expose patients to the risk of more
severe cognitive impairment without additional therapeutic gains.
Seizure threshold is determined by trial and error ("dose titration").
Some psychiatrists use dose titration, some still use "fixed dose" (that is,
all patients are given the same dose) and others compromise by roughly
estimating a patient's threshold according to age and sex.

Immediately prior to treatment, a patient is given a short-acting

anesthetic, a muscle relaxant. In a minority of countries such as Japan,
India, and Nigeria, ECT may be used without anesthesia.

Devices
Most modern ECT devices deliver
a brief-pulse current, which is
thought to cause fewer cognitive
effects than the sine-wave
currents which were originally
used in ECT. A small minority of
psychiatrists in the USA still use
sine-wave stimuli. Sine-wave is no
longer used in the UK or Ireland.
Typically, the electrical stimulus
used in ECT is about
800 milliamps and has up to several hundred watts, and the current
flows for between one and 6 seconds.

Mechanism Of Action
Despite decades of research, the exact mechanism of action of ECT
remains elusive. Neuroimaging studies in people who have had ECT,
investigating differences between responders and non-responders, and
people who relapse, find that responders have anticonvulsant effects
mostly in the frontal lobes, which corresponds to immediate responses,
and neurotrophic effects primarily in the medial temporal lobe. The
anticonvulsant effects are decreased blood flow and decreased
metabolism, while the neurotrophic effects are opposite - increased
perfusion and metabolism

References
1. http://www.mayoclinic.org/tests-procedures/electroconvulsivetherapy/basics/results/prc-20014161
2. Madhavan Seshadri; Nadeem Z Mazi-Kotwal. "Response
Predictors in ECT: A discussion about Seizure Threshold"