Neuropathological Evaluation of an 84-Year-Old Man After 422 ECT Treatments

Anderson, Danielle; Wollmann, Robert L.; Dinwiddie, Stephen H.

doi:10.1097/yct.0000000000000062

Cited by 11 publications

(6 citation statements)

References 11 publications

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“… 116 It has been demonstrated definitively that ECT does not cause structural brain damage, 140 even in patients who have received hundreds of lifetime treatments. 1 Additionally, cognitive side effects from acute ECT do not worsen with mECT. 119 Reports suggest ECT has no long-term impact on cognition, 141 even in patients receiving upward of 100 lifetime treatments, 142 in patients with preexisting dementia, 143 , 144 or in the still-developing brain.…”

Section: Evaluation and Managementmentioning

confidence: 99%

“…The catatonic syndrome separating this man from his world and its exquisite responsiveness to electroconvulsive therapy (ECT) had inspired countless cohorts of medical students, and was eventually reported. 1 Catatonia and ECT share an interwoven past over the last century. Catatonia is a neuropsychiatric syndrome characterized by behavioral and motor disturbances.…”

Section: Introductionmentioning

confidence: 99%

Figure 1 Prevalence of catatonia. Insufficient prevalence data for other conditions frequently cooccurring with catatonia include: obsessive-compulsive disorder, Tourette’s syndrome, alcohol/sedative withdrawal, and selective mutism.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

<p>Electroconvulsive Therapy for Patients with Catatonia: Current Perspectives</p>

Lloyd¹,

Silverman²,

Kugler³

et al. 2020

NDT

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Catatonia is a serious, common syndrome of motoric and behavioral dysfunction, which carries high morbidity and mortality. Electroconvulsive therapy (ECT) is the definitive treatment for catatonia, but access to ECT for the treatment of catatonia remains inappropriately limited. Catatonia is observable, detectable, and relevant to various medical specialties, but underdiagnosis impedes the delivery of appropriate treatment and heightens risk of serious complications including iatrogenesis. Current understanding of catatonia's pathophysiology links it to the current understanding of ECT's mechanism of action. Definitive catatonia care requires recognition of the syndrome, workup to identify and treat the underlying cause, and effective management including appropriate referral for ECT. Even when all of these conditions are met, and despite well-established data on the safety and efficacy of ECT, stigma surrounding ECT and legal restrictions for its use in catatonia are additional critical barriers. Addressing the underdiagnosis of catatonia and barriers to its treatment with ECT is vital to improving outcomes for patients. While no standardized protocols for treatment of catatonia with ECT exist, a large body of research guides evidence-based care and reveals where additional research is warranted. The authors conducted a review of the literature on ECT as a treatment for catatonia. Based on the review, the authors offer strategies and future directions for improving access to ECT for patients with catatonia, and propose an algorithm for the treatment of catatonia with ECT.

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Section: Evaluation and Managementmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

<p>Electroconvulsive Therapy for Patients with Catatonia: Current Perspectives</p>

Lloyd¹,

Silverman²,

Kugler³

et al. 2020

NDT

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“…McCall et al have listed some misconceptions concerning the mechanism underlying the treatment effects of ECT, such as brain damage and the placebo effect [9]. Anderson et al performed a postmortem brain examination on an 84-year-old man after 422 ECT sessions and found no identifiable structural changes in his brain [10], which further confirmed the results of previous research [11,12]. It is notable that in Anderson's study, the time interval between the last ECT treatment and the postmortem examination was less than a month, which is much shorter than in the previous reports (one year and 12 years).…”

Section: Discredited Theories Of Ectmentioning

confidence: 99%

Potential Mechanisms Underlying the Therapeutic Effects of Electroconvulsive Therapy

Jiang

Wang

2016

Neurosci. Bull.

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In spite of the extensive application of electroconvulsive therapy (ECT), how it works remains unclear. So far, researchers have made great efforts in figuring out the mechanisms underlying the effect of ECT treatment via determining the levels of neurotransmitters and cytokines and using genetic and epigenetic tools, as well as structural and functional neuroimaging. To help address this question and provide implications for future research, relevant clinical trials and animal experiments are reviewed.

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“… 35 , 36 Interestingly, a case report detailing post-mortem brain examination of an 84-year-old man who had undergone 422 ECT sessions described no significant microscopic abnormalities, once again suggesting that ECT is not associated with identifiable structural brain injury. 37 Despite this apparent consensus regarding a lack of association between ECT and neural injury, methodological variations exist between the studies described above suggesting that caution is required when interpreting such findings; these variations will be discussed in a later section.…”

Section: Studies Of Ect and Neural Injurymentioning

confidence: 99%

The role of APOE-ɛ4 and beta amyloid in the differential rate of recovery from ECT: a review

et al. 2015

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Individual biological differences may contribute to the variability of outcomes, including cognitive effects, observed following electroconvulsive treatment (ECT). A narrative review of the research literature on carriage of the apolipoprotein E ɛ4 allele (APOE-ɛ4) and the protein biomarker beta amyloid (Aβ) with ECT cognitive outcome was undertaken. ECT induces repeated brain seizures and there is debate as to whether this causes brain injury and long-term cognitive disruption. The majority of ECT is administered to the elderly (over age 65 years) with drug-resistant depression. Depression in the elderly may be a symptom of the prodromal stage of Alzheimer's disease (AD). Carriage of the APOE-ɛ4 allele and raised cerebral Aβ are consistently implicated in AD, but inconsistently implicated in brain injury (and related syndromes) recovery rates. A paucity of brain-related recovery, genetic and biomarker research in ECT responses in the elderly was found: three studies have examined the effect of APOE-ɛ4 allele carriage on cognition in the depressed elderly receiving ECT, and two have examined Aβ changes after ECT, with contradictory findings. Cognitive changes in all studies of ECT effects were measured by a variety of psychological tests, making comparisons of such changes between studies problematic. Further, psychological test data-validity measures were not routinely administered, counter to current testing recommendations. The methodological issues of the currently available literature as well as the need for well-designed, hypothesis driven, longitudinal studies are discussed.

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Neuropathological Evaluation of an 84-Year-Old Man After 422 ECT Treatments

Cited by 11 publications

References 11 publications

<p>Electroconvulsive Therapy for Patients with Catatonia: Current Perspectives</p>

<p>Electroconvulsive Therapy for Patients with Catatonia: Current Perspectives</p>

Potential Mechanisms Underlying the Therapeutic Effects of Electroconvulsive Therapy

The role of APOE-ɛ4 and beta amyloid in the differential rate of recovery from ECT: a review

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