Electroconvulsive therapy treatment in patients with somatic symptom and related disorders

Leong, Kawai; Tham, Joseph; Scamvougeras, Anton; Vila‐Rodriguez, Fidel

doi:10.2147/ndt.s90969

Cited by 13 publications

(19 citation statements)

References 66 publications

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“…2 It is possible that the effect of ECT on CRPS may be due to the beneficial effect of ECT on the co-morbid depression in CRPS patients, but ECT has been used in the treatment of pain such as phantom limb pain and somatic pain as well as CRPS for over 50 years. 4 Therefore, it can be concluded that the transient, but complete recovery from pain in our patient resulted from the neuromodulation effect of prolonged status epilepticus, and it did not last for more than several weeks as in ECT therapy. In addition, the temporary improvement of CRPS may be in part attributable to the treatment of midazolam or other antiepileptic drugs, because there are reports of the effects of ketamine, another widely used antiepileptic drug for status epilepticus, on the CRPS.…”

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confidence: 58%

“…It has long been revealed that nociception threshold is high in epilepsy patients, and monoamine-mediated modulation of central pain inhibitory system is responsible for the ictal and post-ictal analgesia in these patients. 4 Although central pain modulation is an important mechanism of pathogenesis in chronic CRPS, there is limited information on the analgesic role of seizure or status epilepticus in CRPS patients. We only found several reports on the beneficial effects of 'convulsion' of ECT on CRPS patients.…”

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confidence: 99%

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Recovery from Complex Regional Pain Syndrome after Super Refractory Status Epilepticus

Kim

Lee

et al. 2019

Epilia: Epilepsy Commun

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Complex regional pain syndrome (CRPS) is a chronic pain condition characterized by spontaneous and evoked regional pain. CRPS can be differentiated from other chronic pain conditions by the presence of prominent autonomic and inflammatory changes in the region of pain. The exact pathogenesis of CRPS is still unclear, but there seems to be involvement of multiple peripheral and central mechanisms, including peripheral nerve injury, inflammation, neuronal plasticity, and autonomic dysregulation. The relative contributions of these different mechanisms probably differ from one individual patient to another and even within a patient over time. 1 Although acute CRPS may resolve with conservative medical care, treatment of chronic CRPS is mostly difficult, and there's need for comprehensive multidisciplinary treatment, such as drug treatment, local injection to sympathetic ganglion, spinal cord stimulation, psychological and physical treatment. In intractable CRPS patients, other non-traditional therapeutic approaches such as plasma exchange, medical marijuana, and electroconvulsive therapy (ECT) have been tested. 2 We recently encountered a patient who experienced transient, but complete recovered from CRPS after super refractory status epilepticus. The patient, 55-year-old man was transferred to our hospital with generalized tonic-clonic seizure that lasted for more than 15 minutes. A former construction worker, he became disabled six years ago with multiple fracture in the ribs and the right fibula after falling from a height of three meters. Since the injury, he suffered persistent pain on the back and leg despite the fracture being healed. He described spontaneous, excruciating pain-mainly burning and deep aching-in his back and right lower leg, as well as allodynia and hyperalgesia. A three-phase bone scan showed signs associated with CRPS. He tried several pain treatments, including several opioids, antiepileptic drugs, antidepressants, lumbar epidural block, regional sympathetic nerve blocks, transcutaneous nerve stimulation as well as acupuncture. All these treatments had an insufficient effect. At the time of admission, the patient was comatose, and did not responded to painful stimuli. He was receiving duloxetine 60 mg, pregabalin 600 mg, oxcarbazepine 600 mg, tapentadol 400 mg, clonazepam 4.5 mg, oxycodone 80mg, and trazodone 100 mg. Initial brain MRI including diffusion-weighted image showed no abnormality, but EEG, which was performed at two hours after the admission, showed continuous 2-Hz spike and waves in both frontal areas (Fig. 1), which lasted for three days and terminated with

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confidence: 58%

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confidence: 99%

Recovery from Complex Regional Pain Syndrome after Super Refractory Status Epilepticus

Kim

Lee

et al. 2019

Epilia: Epilepsy Commun

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“…Other studies examining the effect of ECT on somatic symptoms Leong et al 17 . completed a retrospective chart review over a 10‐year period of inpatients in a psychiatric ward diagnosed with somatoform disorder and who experienced a change in somatic symptoms following ECT.…”

Section: Discussionmentioning

confidence: 99%

ECT and somatoform disorder: case report and literature review

Lau

Burlingham

Quraishi

2021

Prog Neurol Psychiatry

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Patients with somatoform disorders can be significantly impacted by the condition and there is often comorbid depression and anxiety. In cases that are treatment resistant, with the disorder persisting despite intensive psychological input and numerous psychotropic medications, the use of electroconvulsive therapy (ECT) has been considered a possible treatment option. Here, the authors report the case of such a patient who responded to ECT treatment and present a literature review exploring the topic.

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“…It has also been used for chronic pain with or without depressive symptoms [ 2 ]. A recent report indicated that ECT is effective for somatoform disorders or somatic-symptom-related disorders [ 3 ]. Deleterious changes in injured neurons associated with nociceptive receptors and descending modulatory pathways in the central nervous system can cause neuropathic pain.…”

Section: Introductionmentioning

confidence: 99%

Efficacy of Electroconvulsive Therapy for Neuropathic Pain Comorbid with Major Depression

Ueda

Konishi

Sakurai

et al. 2020

Case Reports in Psychiatry

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We report a case of a 41-year-old male with postinjury neuropathic pain comorbid with major depression in which electroconvulsive therapy (ECT) was effective in relieving both neuropathic pain and major depression. A total of 12 sessions of bilateral ECT were performed using a Thymatron® (Somatics LLC; Lake Bluff, IL). After ECT, the patient was subsequently maintained on paroxetine, eszopiclone (2 mg/day), and alprazolam. There was no relapse for at least one year after the last ECT. This case indicates that ECT might be an alternative treatment for major depression associated with chronic neuropathic pain after traumatic injury.

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Electroconvulsive therapy treatment in patients with somatic symptom and related disorders

Cited by 13 publications

References 66 publications

Recovery from Complex Regional Pain Syndrome after Super Refractory Status Epilepticus

Recovery from Complex Regional Pain Syndrome after Super Refractory Status Epilepticus

ECT and somatoform disorder: case report and literature review

Efficacy of Electroconvulsive Therapy for Neuropathic Pain Comorbid with Major Depression

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