Biomedical subjects
Publications and source records attributed to C. Edward Coffey.
We describe a depressed man with an asymptomatic arachnoid cyst of the left sylvian fissure who was successfully treated with ECT. Magnetic resonance imaging of the brain before and after the course of therapy revealed no change in the cyst nor any injury to the surrounding brain parenchyma.
The authors review their experience with brain magnetic resonance (MR) imaging in elderly patients with depression referred for electroconvulsive therapy (ECT). A variety of brain changes were identified on the pre-ECT MR scans of these patients, including cortical atrophy, subcortical encephalomalacia, lateral ventricular enlargement, and lesions of the pons. The authors examine the effects of these preexisting brain changes on the therapeutic outcome and side effects from ECT. Pilot data suggest that these brain findings do not change during a course of ECT. The potential relationship of these brain changes to the development of affective disorder in the elderly is discussed and areas for future research are suggested.
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This naturalistic study followed the course of 27 patients who received continuation therapy with outpatient electroconvulsive therapy (ECT) after responding well to an index course of ECT for major depression. The continuation outpatient ECT protocol consisted of weekly treatments for the 1st month after remission, followed by a gradual tapering to monthly treatments. All patients were free of psychotropic medications during their continuation course of ECT. Patients who completed the continuation ECT protocol were significantly (p = 0.04) less likely to experience a relapse of depressive symptoms necessitating hospitalization during a 5-month follow-up period than were those who failed to follow the protocol. Indications for use of continuation ECT are discussed and areas for future research are identified.
The authors describe a pilot investigation using ambulatory polysomnography (PSG) to assess rapid eye movement (REM) latency in 11 depressed inpatients before and after a course of electroconvulsive therapy (ECT). Prior to beginning ECT, all subjects had REM latencies of 56 minutes or less (mean 22 min). A course of ECT was associated with clinical improvement in every patient and a statistically significant (p < 0.0002) increase of 67% in mean REM latency (37 min). However, individual patients showed marked variability in REM latency both during and after the course of ECT, and 7 of the 11 responders continued to exhibit shortened REM latencies of 34 min or less. Technical considerations related to PSG studies during ECT are reviewed and the clinical and theoretical implications of our findings are discussed.
A depressed woman with multiple sclerosis was successfully treated with electroconvulsive therapy without any adverse effects to her neurologic status. Magnetic resonance imaging of the brain was performed before and after the course of therapy and revealed no change in the white matter lesions visualized on spin-echo images.
We report a depressed man, with a ventriculoatrial shunt for normal pressure hydrocephalus, who was successfully treated with electroconvulsive therapy (ECT). The management of patients who have brain shunts and who are referred for ECT is discussed.
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The authors describe a depressed patient with osteogenesis imperfecta, osteoporosis, and vertebral compression fractures, who was successfully treated with electroconvulsive therapy (ECT). The management during ECT of patients at increased risk of fractures is discussed.
Conflicting results continue to be reported for studies contrasting the therapeutic efficacy of bilateral and unilateral nondominant electroconvulsive therapy (ECT). At least in part, the therapeutic advantage for bilateral ECT observed by some investigators may be related to the use of nonoptimum unilateral ECT technique. Consideration of technique-related factors, such as stimulus electrode location, contact at the electrode-scalp interface, stimulus dosing, and seizure monitoring, will allow unilateral ECT to be carried out with maximal therapeutic potency.