Preliminary Guidelines for Resuming Electroconvulsive Therapy After a Complication of Status Epilepticus.

ABSTRACT: Electroconvulsive therapy (ECT) is an effective and safe treatment for severe major depressive disorder. However, status epilepticus is a rare yet serious complication that can occur following treatment. We present a case of a patient with severe major depression who experienced convulsive status epilepticus during the first treatment of her fourth ECT course. Electroconvulsive therapy treatment was then discontinued, and the patient underwent unsuccessful medication trials. Due to deterioration of depressive symptoms, ECT resumption was considered 3 months later after the patient had been maintained on an antiepileptic drug and no further seizures had occurred. Electroconvulsive therapy was resumed with a detailed safety protocol that included electroencephalographic monitoring before and after ECT treatment, remaining on an antiepileptic drug during the course of treatment, performing ECT in the operating room, and preparing seizure-terminating drugs before each treatment. The patient completed her ECT course with no tardive seizures or other neurological complications. We present the safety measures taken for resumption of ECT in our patient, and we offer preliminary clinical guidelines for resuming ECT after a complication of status epilepticus.

Remote physiological monitoring of acute cocaine exposure.

Cocaine exposure results in predictable cardiovascular changes. The current study evaluated the utility of BioHarness for assessing cardiovascular and respiratory changes following cocaine exposure (0 and 40 mg, IV) under controlled laboratory conditions. Participants (n = 28) included non-treatment-seeking, cocaine-dependent volunteers. Results showed that BioHarness was able to detect a significant increase in heart rate following cocaine exposure, in comparison to placebo, (p < 0.0001). Additionally, heart rate values obtained using BioHarness were significantly correlated with those obtained from standard hospital equipment (p < 0.001). Significantly greater peak effects in breathing rate were also observed (p = 0.04). BioHarness is a promising remote physiological monitoring device that can accurately assess exposure to cocaine in the laboratory and may provide additional advantages when compared to standard hospital equipment.

Preliminary findings of the effects of rivastigmine, an acetylcholinesterase inhibitor, on working memory in cocaine-dependent volunteers.

Long-term cocaine use is a risk factor for the onset of neurocognitive impairment. This study sought to determine whether the cholinesterase inhibitor rivastigmine could improve neurocognitive performance in cocaine-dependent individuals. Cocaine-dependent individuals who were not seeking treatment at the time of enrollment in the study were randomly assigned to receive placebo (n=16), rivastigmine 3mg (n=13), or rivastigmine 6mg (n=12). The baseline neurocognitive assessment, which included measures of attention/information processing (as measured by the Continuous Performance Task-II (CPT-II)), verbal learning/episodic memory (as measured by the Hopkins Verbal Learning Test-Revised (HVLT-R)), and working memory (as measured by the Dual N-Back Task), was conducted prior to the administration of study medication (Day 0). The follow-up assessment was conducted on Day 8 after the participants had received rivastigmine or placebo for 7days (Day 2-8). Rivastigmine administration significantly improved performance on one measure of working memory span (mean n-back span). This study provides additional data showing that cocaine-associated neurocognitive impairment, specifically working memory deficits, can be remediated, at least to some degree.