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Biomedical subjects

R D Weiner

Publications and source records attributed to R D Weiner.

At least 19 recordsLinked to original sources
PubMed1991

Brain anatomic effects of electroconvulsive therapy. A prospective magnetic resonance imaging study.

To determine prospectively whether electroconvulsive therapy (ECT) produces structural brain changes, 35 inpatients with depression underwent magnetic resonance imaging before and twice after (at 2 to 3 days and at 6 months) completion of a course of brief-pulse, bilateral ECT. The magnetic resonance images were analyzed blindly for evidence of changes in brain structure using two approaches: measurement of regional brain volumes and a pairwise global comparison. Structural brain abnormalities were present in many patients before ECT. The course of ECT produced no acute or delayed (6-month) change in brain structure as measured by alterations of the total volumes of the lateral ventricles, the third ventricle, the frontal lobes, the temporal lobes, or the amygdala-hippocampal complex. In five subjects, the pairwise global comparisons revealed an apparent increase in subcortical hyperintensity, most likely secondary to progression of ongoing cerebrovascular disease during follow-up. Our results confirm and extend previous imaging studies that also found no relationship between ECT and brain damage.

Amygdala↗
PubMed1991

The monitoring and management of electrically induced seizures.

Because induced seizures have such a fundamental influence on both beneficial and adverse effects associated with ECT, it is crucial that they be monitored as effectively as possible. In practice this process involves a combination of both motor and EEG monitoring. The technology for such monitoring, although not overly sophisticated, is also not trivial, and a certain amount of training is required before a practitioner can meaningfully interpret this type of information. Efforts to standardize monitoring practices, at least within a particular ECT program, are also indicated. Our knowledge of what constitutes an adequate seizure is limited, with duration still the primary focus. Future studies of ictal electrophysiology may well provide better answers in this regard. One area where already accomplished work has proved productive involves the delineation of many of the factors which influence seizure threshold and duration. On the basis of these data, practitioners now can exert considerably greater control over such measures, and thereby make more optimal use of this treatment modality.

Electroconvulsive Therapy↗
PubMed1991

Electroconvulsive therapy in the United States.

In 1990, electroconvulsive therapy (ECT) celebrated 50 years of continuous use in the United States. After many trials and tribulations, this treatment modality has experienced a resurgence of interest in recent years. Contemporary research has helped to both maximize benefits and minimize risks, as ECT has grown technologically into a sophisticated procedure administered by highly trained practitioners. Given the substantial growth in knowledge about ECT, the American Psychiatric Association has recently developed comprehensive clinical guidelines for its practice. The present paper provides an overview of the history of ECT in the United States, the manner in which it is used at present, and areas of active research interest.

Animals↗
PubMed1991

Practical issues in the use of electroconvulsive therapy (ECT).

ECT is a safe and effective treatment for affective disorders and certain types of schizophrenia. It is also useful as a form of continuation/maintenance therapy in otherwise resistant cases. The referral of a patient for ECT is based on a careful risk-benefit analysis of all viable treatment options. The administration of ECT in the present era is a refined, technically sophisticated procedure which should be performed only by practitioners with established competency to do so. With proper understanding of risk factors and treatment technique, modifications of the ECT procedure can now frequently be made to minimize adverse effects and to maximize therapeutic response.

Electroconvulsive Therapy↗
PubMed1990

Cardiovascular response to unilateral electroconvulsive therapy.

Few studies have examined the cardiovascular response to pulse unilateral electroconvulsive therapy (ECT) performed using modern techniques. In this study of 30 patients (mean age 62 years) with major depression, we determined the effects of pulse unilateral ECT on cardiac work load using the rate-pressure product (RPP), a product of pulse and systolic blood pressure. The mean RPP across all ECT treatments increased by an average of 96% from pre-ECT baseline, with the maximal RPP occurring typically during the seizure. The amount of increase in RPP did not differ significantly over the course of treatments. The increase in RPP was significantly and inversely related to baseline RPP, such that subjects with the highest baseline RPPs actually had smaller increases in RPP during the ECT treatments. The mean percent change in RPP was not associated with age, sex, presence of cardiovascular disease, ECT stimulus charge, EEG seizure duration, or amnestic side effects. There was a trend (p = 0.06), however, for the mean increase in RPP to be greater in responders (100% increase, n = 25) than in nonresponders (76% increase, n = 5). The potential relationship of clinical outcome to the increase in RPP suggests that both factors may be manifestations of the physiological intensity of the ECT-induced seizure.

Adult↗
PubMed1990

Caffeine augmentation of ECT.

In a randomized, double-blind, placebo-controlled pilot study of 40 depressed inpatients, the authors compared two techniques for maintaining seizure duration during pulse unilateral ECT: pretreatment with intravenous caffeine versus electrical stimulus intensity dosing. Both techniques effectively maintained seizure duration, but with caffeine this was accomplished without any increase in mean stimulus intensity over the course of ECT. There were no differences between the two techniques in therapeutic outcome or cognitive side effects from ECT, and caffeine pretreatment was well tolerated. The authors discuss the clinical and research implications of these findings with respect to strategies for maintaining seizure duration during ECT.

Adult↗
PubMed1990

Electroconvulsive therapy: an update.

Electroconvulsive therapy (ECT) is a safe, rapidly acting, and very effective form of treatment for severe affective illness. In recent years the limitations of available psychopharmacotherapies and the pressures of cost containment appear to be encouraging the increasing use of ECT. The authors provide an overview of electroconvulsive therapy as a treatment modality, focusing on indications, contraindications, adverse effects, and contemporary ECT technique, including recent modifications in electrode placement, stimulus wave form, and dosage intensity. They urge that adequate training be provided for medical and nursing personnel who administer ECT and that facilities monitor practitioners' competence by specific privileging.

Bipolar Disorder↗
PubMed1989

White matter hyperintensity on magnetic resonance imaging: clinical and neuroanatomic correlates in the depressed elderly.

In a prospective study of depressed elderly patients referred for electroconvulsive therapy (ECT), subcortical white matter hyperintensity (WMH) was seen in all 51 patients 60 years or older who received magnetic resonance imaging (MRI) prior to treatment. In over half of the patients the WMH was formally rated as at least moderately severe, and it was commonly associated with other structural brain changes. The majority (80%) of patients had late-age-onset depression, suggesting that structural brain changes may interact with aging to facilitate the emergency of depression in late life.

Aged↗
PubMed1988

Topographic maps of brain electrical activity--pitfalls and precautions.

Topographic mapping of brain electrical activity is a popular, powerful, and potentially misleading technique. The map lies at the end of a long chain of physiological, technical, electronic, and mathematical processes and is vulnerable to artifact, error, and distortion at many points. Close attention must be paid to data collection parameters, subject cooperation, minimization of artifact, limitations of resolutions, selection, and transformation of parameters for display, and map generation strategy to yield an accurate, physiologically interpretable map. Review of the data at each step of analysis, from the paper electroencephalogram (EEG) to sets of maps on video display, may be necessary for optimum understanding. Development of more sophisticated qualitative and quantitative concepts of "normal" physiology is needed. These improvements in electrophysiological data analysis demand, rather than obviate, sophistication on the part of the user.

Arousal↗
PubMed1988

Leukoencephalopathy in elderly depressed patients referred for ECT.

Using brain magnetic resonance imaging (MRI) and high-resolution computed tomography (CT), we identified changes in the subcortical white matter in 44 of 67 elderly depressed inpatients (66%) referred for electroconvulsive therapy (ECT). This "leukoencephalopathy" was frequently associated with other structural brain changes, including cortical atrophy, lateral ventricular enlargement, and lacunar infarctions of the basal ganglia and thalamus. Many (58%) of the patients had developed late-onset depressive disorders, and the majority (86%) had been refractory to and/or intolerant of antidepressant drug therapy. Nevertheless, all but 1 of the 44 patients subsequently responded to a course of ECT, which in general was well tolerated. Although the precise etiology of the leukoencephalopathy remains unclear, clinical data suggest that it may result from arteriosclerotic disease of the medullary arteries that supply the subcortical brain regions. Several lines of evidence suggest that leukoencephalopathy may have implications for the pathophysiology of depressive illness, at least in some elderly patients.

Aged↗
PubMed1988

Effects of ECT on brain structure: a pilot prospective magnetic resonance imaging study.

The authors describe a pilot prospective investigation of the effects of ECT on brain structure using magnetic resonance imaging (MRI). In nine patients with major depression, a course of ECT produced no acute changes in brain structure according to blind raters' assessments of cortical atrophy and global comparison of pre- and post-ECT studies. There were also no significant changes in the ventricle-brain ratios. Pre-ECT brain abnormalities were common in these patients yet were also unaffected by ECT. Future MRI studies of ECT should include more subjects and should address long-term changes and subtle brain abnormalities.

Adult↗