Journal of Ect最新文献

Neuropsychiatric symptoms in dementia can be heterogeneous and hard to treat, though electroconvulsive therapy (ECT) is becoming more widely accepted as a viable treatment option. Here, we describe a patient with Alzheimer disease (AD) who developed Somatic Symptom Disorder as a prodrome to cognitive and functional decline, though atypical, primary affective disorder in AD was also on the differential. This patient further developed debilitating anxiety and agitation that was refractory to multiple behavioral and pharmacological interventions. ECT was able to treat the patient's neuropsychiatric symptoms, resulting in sustained, full remission with minimal transient, cognitive side effects. This case depicts a rare presentation of AD and further adds to the growing body of literature that suggests ECT is safe and effective for treating neuropsychiatric symptoms in dementia.

Background: Electroconvulsive therapy (ECT), repetitive transcranial magnetic stimulation (rTMS), and transcranial direct current stimulation (tDCS) are widely used neuromodulatory interventions for psychiatric disorders. Despite their clinical effectiveness, perceptions and stigma associated with these therapies among caregivers remain a concern, influencing treatment acceptance. This study aimed to estimate the perception and stigma associated with ECT, rTMS, and tDCS among primary caregivers of patients receiving these therapies.

Methods: A cross-sectional comparative study was conducted at the Department of Psychiatry of a Tertiary Care Centre of North India involving 99 primary caregivers whose ages ranged 18 to 60 years and who are staying with the patient for at least 1 year, equally distributed across the 3 therapy groups (ECT, rTMS, and tDCS). Participants were selected using purposive sampling. Data were collected using validated tools: Brain Stimulation Therapy Perception Questionnaire (BSTPQ) and Brain Stimulation Therapy Stigma Questionnaire (BSTSQ).

Results: Caregivers of patients undergoing rTMS and tDCS reported more favorable perceptions and lower stigma compared with ECT caregivers. Statistically significant differences were found between ECT and rTMS groups. A moderate negative correlation was observed between perception and stigma (r=-0.482, P<0.01).

Conclusions: Newer therapies like rTMS and tDCS are perceived more positively than ECT. Education and awareness play a critical role in reducing stigma and improving acceptance among caregivers.

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.