A Feasibility Study of a New Method for Electrically Producing Seizures in Man: Focal Electrically Administered Seizure Therapy [FEAST]

Nahas, Ziad; Short, Baron; Burns, Carol; Archer, Melanie S.; Schmidt, Matthew; Prudic, Joan; Nobler, Mitchell S.; Devanand, D. P.; Fitzsimons, Linda; Lisanby, Sarah H.; Payne, Nicola; Perera, Tarique D.; George, Mark S.; Sackeïm, Harold A.

doi:10.1016/j.brs.2013.03.004

Cited by 62 publications

(43 citation statements)

References 34 publications

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“…The FM electrode configuration had the lowest ST, potentially due to low-resistance current paths into the cranium through the orbits. This observation may be important for other ECT electrode configurations with anterior-posterior injected current flow such as FEAST (Nahas et al, 2013;Spellman et al, 2009). The observed ST variation may be confounded, however, by the differences in train directionality between electrode placements in this study (unidirectional with BL and RUL, and bidirectional with BF and FM) as well as by order effects associated with the sequence of stimulation modality conditions.…”

Section: Stimulus Intensitymentioning

confidence: 77%

“…This suggests that the NHP STs would translate to currents lower than 800 mA in humans. Indeed, recent clinical studies have demonstrated seizure induction with currents as low as 400-500 mA (Nahas et al, 2013;Rosa et al, 2011Rosa et al, , 2012. Notably, these clinical studies used stimulus trains with relatively few pulses (o160 pulses).…”

Section: Stimulus Intensitymentioning

confidence: 99%

“…At conventional pulse amplitudes, ECT induces an electric field strength that substantially exceeds the neural activation threshold in most brain structures (Deng et al, 2011;Lee et al, 2014), resulting in widespread, nonfocal stimulation. This is higher than necessary to induce seizures since ECT studies dating back to the 1940s as well as several small recent studies demonstrated the feasibility of low-amplitude currents inducing seizures (Liberson, 1953;Nahas et al, 2013;Peterchev et al, 2010b;Rosa et al, 2011Rosa et al, , 2012. Furthermore, magnetic seizure therapy (MST) elicits generalized seizures with an induced electric field that is substantially less intense and more focal than conventional ECT (Deng et al, 2011(Deng et al, , 2013Lee et al, 2014).…”

Section: Introductionmentioning

confidence: 99%

“…One approach to individualize the pulse amplitude is by titrating ST with stimulus trains with increasing amplitude (Liberson, 1948(Liberson, , 1953Nahas et al, 2013). This approach, however, has some of the disadvantages of conventional ST titration as it exposes the patients to multiple subthreshold trains and a seizure induction with a threshold stimulus that may be subtherapeutic.…”

Section: Introductionmentioning

confidence: 99%

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Individualized Low-Amplitude Seizure Therapy: Minimizing Current for Electroconvulsive Therapy and Magnetic Seizure Therapy

Peterchev

Krystal

Rosa³

et al. 2015

Neuropsychopharmacol

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Electroconvulsive therapy (ECT) at conventional current amplitudes (800-900 mA) is highly effective but carries the risk of cognitive side effects. Lowering and individualizing the current amplitude may reduce side effects by virtue of a less intense and more focal electric field exposure in the brain, but this aspect of ECT dosing is largely unexplored. Magnetic seizure therapy (MST) induces a weaker and more focal electric field than ECT; however, the pulse amplitude is not individualized and the minimum amplitude required to induce a seizure is unknown. We titrated the amplitude of long stimulus trains (500 pulses) as a means of determining the minimum current amplitude required to induce a seizure with ECT (bilateral, right unilateral, bifrontal, and frontomedial electrode placements) and MST (round coil on vertex) in nonhuman primates. Furthermore, we investigated a novel method of predicting this amplitude-titrated seizure threshold (ST) by a non-convulsive measurement of motor threshold (MT) using single pulses delivered through the ECT electrodes or MST coil. Average STs were substantially lower than conventional pulse amplitudes (112-174 mA for ECT and 37.4% of maximum device amplitude for MST). ST was more variable in ECT than in MST. MT explained 63% of the ST variance and is hence the strongest known predictor of ST. These results indicate that seizures can be induced with less intense electric fields than conventional ECT that may be safer; efficacy and side effects should be evaluated in clinical studies. MT measurement could be a faster and safer alternative to empirical ST titration for ECT and MST.

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Section: Stimulus Intensitymentioning

confidence: 77%

Section: Stimulus Intensitymentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Individualized Low-Amplitude Seizure Therapy: Minimizing Current for Electroconvulsive Therapy and Magnetic Seizure Therapy

Peterchev

Krystal

Rosa³

et al. 2015

Neuropsychopharmacol

View full text Add to dashboard Cite

show abstract

“…In addition, a single-photon emission computed tomography-based study also demonstrated cerebral blood flow reduction in the left frontopolar gyrus in MDD patients after ECT [15]. Moreover, a recently developed variant of ECT, known as focal electrically administered seizure therapy, takes the Fp as targets during treatment of MDD [16,17]. Considering such important roles of the Fp in the MDD patients, thus, investigations of the functional and structural alterations of the Fp in MDD patients after ECT provide us a novel view to understand the mechanism of ECT.…”

Section: Introductionmentioning

confidence: 95%