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Biomedical subjects

Keith G Rasmussen

Publications and source records attributed to Keith G Rasmussen.

At least 19 recordsLinked to original sources
PubMed2006

Patients who develop epilepsy during extended treatment with electroconvulsive therapy.

Epidemiologic data indicate that electroconvulsive therapy (ECT) does not precipitate epilepsy. However, when an ECT patient develops this condition, one is faced with the question as to whether ECT caused it and whether ECT can be safely continued. We describe four patients, two of whom developed definite epilepsy and two possible epilepsy during extended courses of ECT. In one of the patients ECT was stopped at that point, but in the other three, ECT was continued without complications or apparent precipitation of spontaneous seizures. We describe some of the clinical challenges in this scenario and provide recommendations regarding continued use of ECT in the newly diagnosed epileptic patient.

Adult↗
PubMed2006

Electroconvulsive therapy in patients with epilepsy.

There are scant published data to guide the clinician about safe and effective use of electroconvulsive therapy (ECT) in epileptic patients who suffer from psychiatric disorders. In this report, we describe our experience treating 43 epileptic patients with ECT. Seven of the patients may have had spontaneous seizures during the course of treatments, although the possibility of pseudoseizures or nonictal phenomena seemed quite likely in several of these cases. For the majority of patients, adequate seizures could be obtained during ECT despite concomitant treatment with antiepileptic medications, although dose reductions were required in a few cases. Most patients enjoyed moderate to marked reductions in psychiatric symptoms with ECT, and one patient seemed to have a marked reduction in spontaneous seizure frequency for several weeks after completion of the ECT course. We conclude that most epileptic patients can be treated with ECT without dose adjustment in antiepileptic medications and provide general recommendations for safe use of ECT in this population.

Adolescent↗
PubMed2006

Nonconvulsive seizures in electroconvulsive therapy: further evidence of differential neurophysiological aspects of bitemporal versus bifrontal electrode placement.

In recent years, attention has been focused on the role of electrode placement in determining efficacy and cognitive side effects of electroconvulsive therapy (ECT). In particular, interest in bifrontal electrode placement has increased. Some evidence indicates differential therapeutic, cognitive, and neurophysiological aspects of bifrontal versus bitemporal ECT. Occasionally in ECT practice, electroencephalographic seizure activity is manifested in the absence of motor convulsive activity, a phenomenon termed nonconvulsive seizures. This probably indicates isolated prefrontal seizure activity in the absence of motor strip involvement. We reviewed our records and found that bifrontally treated patients had a significantly higher incidence of nonconvulsive seizures in ECT than did bitemporally treated patients. Seizure threshold was also higher among the bifrontal patients. We hypothesize that this provides further evidence of differential neurophysiology of seizures induced with these 2 electrode placements.

Cognition Disorders↗
PubMed2006

Patterns of psychotropic medication use among patients with severe depression referred for electroconvulsive therapy: data from the Consortium for Research on Electroconvulsive Therapy.

Most studies of trends in antidepressant pharmacotherapy have focused on relatively mildly ill, nonpyschotic outpatients. In this report, we provide detailed information on psychotropic use among patients with unipolar depression participating in a large, multisite electroconculsive therapy (ECT) study. Adequacy of antidepressant medication trials was assessed with the Antidepressant Treatment History Form. Among patients with nonpsychotic depression, 27% (60/220) had not had an adequate trial of an antidepressant before ECT, and 63% (139/220) had had at least one inadequate trial. Surprisingly, 33% (79/243) of nonpsychotic patients had been prescribed an antipsychotic. Among patients with psychotic depression, 95% (101/106) had not been given an adequate combination of an antidepressant and antipsychotic agent, mostly due to low doses of the latter class. Among all patients in the trial, 61% (213/352) had been prescribed at least one benzodiazepine, and only 7% (24/352) had been given a lithium augmentation trial. Use of hypnotic agents and anticonvulsants was common. In conclusion, patients with severe depression referred for ECT with a unipolar depressive episode have high rates of psychotropic usage, much of which is inadequate.

Adolescent↗
PubMed2006

Blood glucose before and after ECT treatments in Type 2 diabetic patients.

Electroconvulsive therapy (ECT) is often performed for patients with psychiatric disorders who also have diabetes mellitus. Some research has suggested that the course of ECT treatments does not have a consistent effect on blood glucose, but little data exist to inform the clinician about the effects of individual ECT treatments on blood glucose. In this study, 18 patients with type 2 diabetes mellitus were treated with ECT for severe depressive illness. For each patient, a fingerstick blood glucose was routinely obtained before and approximately 20 minutes after each ECT treatment. We found a mean rise of blood glucose after each treatment of approximately 9%, similar to the mean rise of blood glucose among nondiabetic patients undergoing ECT found in a previous study. There were no cases of clinically significant rise or fall in blood glucose. We provide recommendations for management of diabetics during ECT.

Adult↗
PubMed2006

Electroconvulsive therapy in patients with cavernous hemangiomas.

Intracranial vascular malformations may potentially increase the risk of complications in electroconvulsive therapy (ECT), although there is only limited case report literature substantiating this. We describe 3 patients with cavernous hemangiomas who received safe, uncomplicated ECT. We provide recommendations for ECT practice in such patients.

Adult↗
PubMed2006

Seizure length with sevoflurane and thiopental for induction of general anesthesia in electroconvulsive therapy: a randomized double-blind trial.

In general, seizure length does not correlate with clinical outcome with electroconvulsive therapy (ECT), but whether markedly short seizures are still therapeutic is unknown. Furthermore, seizure length effects on clinical outcome in ECT may be different among the various anesthetic agents available. Several studies have investigated the use of inhalational anesthesia in ECT with sevoflurane. In general, seizure length when reported has been in the range of typical values encountered in practice. We recently completed a randomized double blind trial with sevoflurane induction compared with thiopental. Seizure duration with sevoflurane anesthesia was 8 seconds shorter than with thiopental for electroencephalogram and 6.4 seconds shorter for motor, the latter just barely missing statistical significance. Absolute values for seizure duration with both sevoflurane and thiopental are well within typical ranges for those seen with the more commonly used methohexital as anesthetic.

Anesthesia, General↗
PubMed2005

The safety of electroconvulsive therapy and lithium in combination: a case series and review of the literature.

Early reports cautioned against the combination of lithium and electroconvulsive therapy (ECT), citing risk of excessive cognitive disturbance, prolonged apnea, and spontaneous seizures. However, recent case series with larger numbers of patients indicate that the combination may be used safely and with optimal efficacy in certain clinical circumstances. In this report, we describe 12 patients in whom the combination of lithium and ECT was deemed safe. We also provide a comprehensive review of published literature and provide detailed recommendations for clinical practice.

Adult↗
PubMed2005

The clinical utility of inhalational anesthesia with sevoflurane in electroconvulsive therapy.

Anesthesia in electroconvulsive therapy (ECT) almost always is induced with intravenous agents, typically barbiturates, etomidate, or propofol. There are, however, circumstances in which an inhalational agent would be preferable for induction of general anesthesia. These uncommon clinical scenarios include severe needle stick phobia, agitation preventing insertion of an intravenous catheter, and poor tolerance of intravenous induction agents. Among the inhalational agents available, sevoflurane has several properties that make it the most desirable. In this case series, we describe several patients in our ECT practice in whom inhalational induction of general anesthesia with sevoflurane was deemed appropriate. In all patients, this method was well tolerated and offered distinct advantages compared with an intravenous induction agent. We conclude that ECT practitioners should keep this option in mind for select patients.

Adult↗
PubMed2005

The effect of electroconvulsive therapy treatments on blood sugar in nondiabetic patients.

There are conflicting data in the literature about the effects of electroconvulsive therapy (ECT) on blood sugar. In general, glycemic control and insulin requirements show no changes over a course of treatments, although there is interindividual variation. What is understudied is the acute effect of single ECT treatments on blood sugar in the post-ictal time period. To shed more light on this issue, we conducted a simple study of blood sugar assessed by fingerstick before and 20 minutes after ECT treatments in 33 nondiabetic patients. There was a small though statistically significant rise of 9 mg/dL in blood glucose after ECT treatments, without effect of age or gender. We conclude that ECT does not have a clinically significant effect on blood sugar in non-diabetic patients.

Analysis of Variance↗
PubMed2004

Relationship between somatization and remission with ECT.

Patients treated with electroconvulsive therapy (ECT) were divided into those with less severe depression and those with more severe depression. In the less severely depressed group, high somatic anxiety and hypochondriasis predicted a low likelihood of sustained remission with ECT. In the more severely depressed group, these traits were not predictive of ECT outcome.

Adult↗
PubMed2004

Lack of effect of ECT on Holter monitor recordings before and after treatment.

OBJECTIVE: There has been concern about persisting cardiac effects of electroconvulsive therapy (ECT). Several studies have analyzed Holter monitor recordings before and after ECT, and generally have found no significant effects. METHODS: As part of a study on heart rate variability changes in ECT, we performed 2-3 hour Holter monitoring before and at least 1 hour after courses of ECT in 11 depressed patients without cardiac illness. RESULTS: There was no significant difference before and after Ect in heart rate, frequency ofventricular or supraventricular events, or in ST segments. CONCLUSION: These date provide further evidnece of the general cardiac safety of ECT.

Adult↗
PubMed2004

Electroconvulsive therapy in a patient with glaucoma.

Electroconvulsive therapy (ECT) is associated with a brief rise in intraocular pressure (IOP). The significance of this in glaucomatous patients is unknown. We present a patient with bilateral glaucoma status after surgery in the right eye who underwent IOP monitoring during 1 of his ECT treatments. Baseline eye pressures were normal at 16 mm Hg and 18 mm Hg immediately before the treatment in the right and left eyes, respectively. Fifteen seconds after seizure induction, there was an approximately 5 mm Hg rise in IOP in the left eye, which lasted approximately 5 minutes before returning to baseline. In the right eye, there was virtually no change in pressure during the seizure. Though further research would be helpful, this case provides evidence that in a glaucomatous patient controlled with medicines or surgery, ECT probably will not cause a significant rise in IOP.

Aged↗
PubMed2004

Changes in heart rate variability in response to treatment with electroconvulsive therapy.

BACKGROUND: Objective methods are needed to determine when to terminate a course of electroconvulsive therapy (ECT). Heart rate variability (HRV) has proven predictive value for patients with cardiac and neurologic disorders and correlates with depression severity and treatment effects. Variable changes in HRV after ECT have been reported. METHODS: Holter monitoring was performed before and after ECT in 11 patients with depression. Measures of HRV were obtained from these recordings and the relationships between HRV and treatment outcome was analyzed. Response to ECT was measured by the 24-item Hamilton Rating Scale for Depression. RESULTS: Standard deviation of interbeat intervals (SDNN, a measure of HRV) increased in subjects who improved with ECT (P < 0.02) but not in those who became confused and agitated. Among those patients who acutely responded to ECT, SDNN increased (P < 0.05) in subjects with a sustained response but not in subjects who relapsed within 3 weeks. SDNN was significantly lower in the rapid relapse group at baseline (P < 0.05) and after ECT (P < 0.05) compared with the group with a sustained response. CONCLUSIONS: Low baseline HRV is associated with rapid relapse of depression after ECT. Both high baseline HRV and increasing HRV predict a sustained outcome. Further research is necessary to support these findings and to clarify if the serial measurement of HRV during ECT may help to determine the optimal number of treatments for each patient.

Adult↗
PubMed2004

Morbidity and mortality in the use of electroconvulsive therapy.

There are a few large studies of the morbidity and mortality of electroconvulsive therapy (ECT). To add data to this literature, we performed a retrospective review of all the patients who underwent ECT at our institution between January 1, 1988, through December 31, 2001. We identified 2,279 patients who were given 17,394 ECT treatments during their first series. The median number of treatments received per patient was 7. Twenty-one patients (0.92%) experienced a complication at some time during their first series of ECT treatments. Cardiac complications, mostly arrhythmias, constituted the majority. However, none of the complications caused permanent injury, and none of the patients died during or immediately after ECT. There were 18 deaths within 30 days of the final treatment, none related to ECT. These data are concordant with those of other published large series, and we conclude that ECT is an extremely safe procedure.

Adult↗
PubMed2004

Electroconvulsive therapy in patients taking monoamine oxidase inhibitors.

Concerns have been expressed regarding the use of general anesthesia for electroconvulsive therapy (ECT) in patients taking monoamine oxidase inhibitors (MAOIs). We review the published literature and present 4 new cases and conclude that there is no evidence of a dangerous interaction between ECT and MAOI use. In general, a cautious approach would be to discontinue MAOIs before ECT if the medication has not been helpful; however, there is no need for a washout interval before starting ECT. Furthermore, if there is otherwise a reason for continuing the MAOI, it can be continued during index ECT or initiated during maintenance ECT.

Aged↗
PubMed2004

Electroconvulsive therapy in patients with cardiac pacemakers and implantable cardioverter defibrillators.

Electroconvulsive therapy (ECT) is used to treat major depressive illness, especially in elderly and medically frail patients. Not uncommonly, these patients have cardiac pacemakers or implantable cardioverter defibrillators (ICDs). Only a few case reports in the literature describe the use of ECT in such patients. Herein we review our ECT experience treating 26 pacemaker patients and 3 ICD patients. All patients obtained significant antidepressant benefits with ETC. Only one serious cardiac event occurred, a case of supraventricular tachycardia (SVT) requiring a stay on the cardiac intensive care unit. The SVT resolved and the patient went on to receive further uncomplicated ECT treatments. We conclude from this experience that with proper pre-ECT cardiac and pacemaker/defibrillator assessment, ECT can be safely and effectively administered to patients with an implanted cardiac device.

Aged↗