Journal of Ect最新文献

We describe a young man with Wiedemann-Steiner syndrome (WSS) suffering from severe depression with psychotic and catatonic features, who showed a marked and lasting response to electroconvulsive therapy (ECT). Resting-state electroencephalogram (EEG) was recorded before and after the ECT course in the patient, and-at comparable time points-in his monozygotic twin brother. This offered unique neurophysiological insights into candidate mechanisms underlying ECT's therapeutic effects. After 16 ECT sessions, the patient completely remitted. Pretreatment EEG of the patient showed a lower amplitude, less fluctuating and more symmetrical posterior dominant rhythm, which partly normalized after the successful ECT course. Quantitative EEG analyses using a computational corticothalamic model suggested that thalamic intrinsic responsiveness in the recovered patient decreased, normalizing toward his twin brother's values after the ECT course. These findings may point to normalization of thalamic inhibitory function as a candidate mechanism of the therapeutic effect of ECT in treating catatonic psychotic depression.

Background: Negative symptoms in schizophrenia are associated with long-term disability and poor functional outcomes. These symptoms remain inadequately addressed by current pharmacological and psychosocial interventions. Neuromodulation strategies, such as combining transcranial magnetic stimulation and transcranial direct current stimulation, are emerging as promising noninvasive options.

Objectives: This study aimed to assess the efficacy and safety of combining cathodal high-definition transcranial direct current stimulation with intermittent theta burst stimulation for reducing negative symptoms in patients with schizophrenia.

Materials and methods: In this randomized, double-blind, sham-controlled trial, 40 inpatients diagnosed with schizophrenia with predominantly negative symptoms were assigned to receive either active or sham priming with high-definition transcranial direct current stimulation followed by intermittent theta burst stimulation. Treatment was delivered twice daily over 2 weeks. Clinical assessments were conducted at baseline, after 2 and 4 weeks, using standard rating scales for symptom severity (PANSS, SANS) and global functioning.

Results: Both active and sham groups showed significant within-group improvement in overall symptom scores over time. The active stimulation group demonstrated significantly greater reductions in total and attention-related negative symptom scores. Improvements were also observed in cognitive and depressive domains. The treatment was well tolerated, with only mild and transient side effects reported.

Conclusions: Priming intermittent theta burst stimulation with high-definition transcranial direct current stimulation appears to be a safe and potentially effective approach for targeting negative symptoms in schizophrenia.

Abstract: Frontotemporal dementia (FTD) encompasses a group of clinically, neuropathologically, and genetically heterogeneous disorders characterized by atrophy in the frontal and anterior temporal lobes. Psychiatric and behavioral symptoms are common throughout the course of FTD, and pharmacological treatments show limited efficacy. In this review, we analyzed literature on the use of electroconvulsive therapy (ECT) in patients with FTD to assess its effectiveness and predictors of response in this population. A systematic review was conducted following PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) guidelines, with searches in the MEDLINE, Scopus, and Web of Science databases. Eligibility criteria included original studies and case reports on FTD patients treated with ECT. Of 88 screened abstracts, 25 studies were included, documenting 37 patients with FTD or Pick disease who were treated with ECT. ECT was primarily administered for catatonia (37.84%) and depressive episodes (35.14%). Most patients had not responded to at least 1 prior medication, primarily antipsychotics. Following the initial ECT course, 40.54% of patients experienced symptom remission, 21.62% showed partial or transient improvement, and 32.43% saw little to no benefit. Continuation and maintenance ECT appeared to be valid treatment options following a response to acute ECT. Notably, patients with the C9orf72 mutation showed a poor response to ECT. For many FTD patients with behavioral, mood, and catatonic symptoms, ECT appears to be more effective than pharmacological treatments; however, its impact on cognition and long-term outcomes requires further investigation. Systematic clinical studies on larger samples are necessary to confirm the efficacy and tolerability of ECT for psychiatric disorders in FTD.

New-onset refractory status epilepticus (NORSE) is a severe and often fatal neurological condition characterized by continuous or recurrent seizures unresponsive to standard antiseizure therapies. Management remains highly challenging due to unclear etiologies and resistance to conventional treatment. Electroconvulsive therapy (ECT) has emerged as a potential intervention. This study systematically reviewed reported NORSE cases treated with ECT to evaluate efficacy, safety, and outcomes. A comprehensive literature search of PUBMED, EMBASE, and SCOPUS was conducted in June 2024. English-language reports describing ECT-managed NORSE cases were included, while studies focusing on psychiatric disorders or lacking specific neuromodulation details were excluded. Extracted data included demographics, clinical presentation, EEG and imaging findings, prior treatments, ECT parameters, complications, and clinical outcomes. Of 1039 records screened, 5 studies encompassing 6 cases met the inclusion criteria; combined with our local case, 7 total cases were analyzed. The mean patient age was 37.1 years, and 57% were female. Neuroimaging abnormalities were present in 71% of cases, and cerebrospinal fluid abnormalities in 40%. All patients received multiple antiseizure medications (mean 7) before ECT. The average number of ECT sessions was 9.7. Seizure remission occurred in 71% of cases, with partial improvement in 29%. Cognitive impairments were observed in 42% of patients, and overall functional outcomes varied. ECT demonstrated notable efficacy as salvage treatment for NORSE, achieving seizure remission or reduction in most patients without severe adverse effects. These findings support ECT as a potential therapeutic option in NORSE when standard interventions fail.

We report an 80-year-old male with nonshunted normal pressure hydrocephalus (NPH) presenting with an episode of recurrent major depressive disorder who underwent electroconvulsive therapy (ECT) with good effect and consequent amelioration of neuropsychiatric symptoms. NPH had been diagnosed several years prior, although a shunt was not pursued. On admission, it proved initially challenging to separate a mood disorder from behavioral and psychological symptoms of dementia (BPSD), as is the case for many patients with NPH. Following the diagnosis of recurrent major depressive disorder, the patient underwent 14 sessions of ECT. This resulted in a marked and sustained improvement in psychiatric symptoms. This case supports the putative safety of ECT for patients with nonshunted NPH and demonstrates the potentially long-term psychiatric benefit of ECT in this patient population.

Headache is among the most frequently reported side effects of electroconvulsive therapy (ECT), yet it remains understudied and inconsistently managed. This systematic review aimed to synthesize and evaluate the effectiveness of pharmacological and nonpharmacological interventions for post-ECT headache. We conducted a comprehensive search of PubMed and Scopus databases up to July 2025 to identify all reports involving therapeutic interventions specifically targeting post-ECT headache. Seventeen articles were included, comprising case reports, case series, observational studies, and one randomized controlled trial. Treatments evaluated included sumatriptan, nonsteroidal anti-inflammatory drugs (NSAIDs), paracetamol, propranolol, topiramate, valproic acid, mirtazapine, dihydroergotamine, topical salicylates, cryotherapy, and percutaneous electrical nerve stimulation. Sumatriptan, supported only by observational studies, showed the most consistent benefit for acute headache relief, particularly in patients presenting with migraine-like symptoms. Prophylactic agents such as topiramate, valproic acid, and propranolol were effective in individual cases, especially for recurrent or severe headache phenotypes. NSAIDs demonstrated limited efficacy for post-ECT headache, although they may provide some benefit for myalgia. In contrast, paracetamol has been supported by evidence from a large randomized controlled trial, which showed a significant reduction in post-ECT headache. Nondrug interventions like cryotherapy showed promise in small cohorts with minimal side effects. Despite growing clinical interest, the quality of available evidence is low and highly heterogeneous. No standardized treatment recommendations currently exist. However, clinical phenotyping and a stepwise therapeutic approach may improve symptom control. This review provides a comprehensive summary of current options and offers guidance for individualized management of post-ECT headache.

Objectives: We aim to determine the safety and outcomes of electroconvulsive therapy (ECT) in patients with ventricular shunts, with a focus on shunt function after treatment.

Methods: We conducted a retrospective analysis of all patients with ventriculoperitoneal shunts who underwent ECT at the Massachusetts General Hospital between November 2021 and November 2024. We also conducted a systematic review of the literature to identify all studies published between November 1, 1964, and November 1, 2024, reporting the use of ECT in patients with implanted cerebrospinal fluid shunts.

Results: Our case cohort comprised 4 patients with implanted programmable VP shunts, of which, 2 cases demonstrated evidence of valve setting changes after ECT. Across all the cases, ECT was effective in reducing psychiatric symptoms without evidence of shunt malfunction, albeit with some ECT-related adverse side effects. Our search yielded 115 studies, of which 12 met the inclusion criteria for review. These studies described the successful administration of ECT in patients with implanted cerebrospinal fluid shunts, with no reports of shunt malfunction or requirement for revision.

Conclusions: ECT appears to be a safe and effective treatment for psychiatric patients with indwelling ventricular shunts. ECT administered to patients with programmable shunt valves require particular attention with evaluation for shunt setting changes and reprogramming to pre-ECT settings when appropriate. Our findings support the need for a multidisciplinary approach, involving psychiatry, anesthesia, and neurosurgical teams, to mitigate risks and optimize care in this unique patient population.

Objectives: Treatment options for premenstrual syndrome (PMS) include lifestyle changes, nutritional supplements, selective serotonin reuptake inhibitors (SSRIs), and hormone therapy. However, these approaches are sometimes ineffective or cause adverse effects. Currently, neuromodulation for premenstrual symptoms remains underrecognized. This study aimed to assess the effects of repetitive transcranial magnetic stimulation (rTMS) on PMS symptoms.

Materials and methods: A prospective pilot study was conducted in which 10 women with PMS were followed up over 2 menstrual cycles. Symptomatic progression was analyzed by assessment instruments at the beginning, middle, and end of the luteal phase in both cycles. The participants underwent 10 to 12 right dorsolateral prefrontal cortex (DLPFC) rTMS sessions during the luteal phase in the second menstrual cycle, and the symptomatic scores of the second cycle (with rTMS) were compared with those of the first cycle (without rTMS).

Results: The intermediate and final assessments indicated a statistically significant decrease in depressive (P = 0.034 and P < 0.001, respectively) and anxiety symptoms (P = 0.019 and P = 0.001, respectively) in the second cycle compared with the first. The rTMS was generally well tolerated without significant adverse effects. The study sample was small, and a control group was not included. Furthermore, the timeframe was short, with only 2 menstrual cycles assessed.

Conclusions: rTMS may provide positive treatment effects for women with PMS, especially in the middle and end of the luteal phase. Future controlled studies to verify its effectiveness are warranted.