Electroconvulsive Therapy

(ECT)

<Management>

<Index>

 

 

Definition

- Electrically induced seizure in an anaesthetised pt as a Mx of psychiatric illness

-  Anaesthesia & muscle relaxant not used in all nations

 

Features

-  Unknown mechanism

-  Aims to induce seizure time > 25 sec

-  Well established as effective but controversial

-  Much public & professional stigma

-  Used in conjunction w counseling & rehab +/- Rx

-  Mostly well tolerated by pts

 

Indications

-  Psychiatric Illness

-  Severe Major Depression: 60-70% remission rate

-  Schizophrenia

-  Mania: Bipolar Disorder

-  May be Mx of choice in potential suicide

-  May be used when severe of unresponsive to Rx

-  Typically 6-12 treatments, 2-3 per week

-  Rx may be given towards end of Mx

 

Procedure

-  Consent required unless part of magistrates order

-  Stop medications (variable)

-  NBM for 12 hours

-  Pt to void bowel & bladder

-  Pt supine, heyper-extend back w pillow

-  Premedicate: anti-cholinergic: Atropine

-  Medications

-  Short acting anaesthetic: Propofol, Thiopentone..

-  Muscle relaxant: Suxamethonium

-  O2 administration (bag & mask)

-  Bite-block/cotton

-  Electrode placement

-  Bilateral (most common)

-  Bifrontal

-  Unilateral (right side)

-  Electrical stimulus

-  Brief pulse

-  1-6 seconds

-  Time seizure via EEG, EMG or hand tonic/clonic movement

-  Monitor until stable (15-30 min)

 

 

Complications

-  Risks ass. w GA

-  Headache, muscle aches (seizure)

-  Post ictal confusion

-  Fractures if insufficient muscle relaxant

-  Memory loss

-  Increased incidence w Bilateral electrode placement & increased current

-  Acute retrograde & antegrade amnesia

-  Chronic usually recovers up to preceeding few weeks

-  Antegrade amnesia short lived

-  Major ongoing problem for some pts

-  Generally accepted as safe during pregnancy

 

Precuation/Contraindications

-  Nil absolute contraindications

-  Increased ICP: CNS herniation

-  Recent AMI: arythmias

 

 

 

References

 

Pic: http://www.sciencephoto.com/images/download_lo_res.html?id=777000017