Electroconvulsive therapy for depression in a patient with an Inspire hypoglossal nerve stimulator device for obstructive sleep apnea: A case report.

OUTCOME OBJECTIVES: METHODS: This is a case report of a patient who underwent placement and initiation of a hypoglossal nerve stimulator device in the context of receiving electroconvulsive therapy for bipolar depression between February and September 2016. To our knowledge, this has not yet been reported in the literature. Outcome measurements included successful device activation and successful device use throughout electroconvulsive therapy. RESULTS: The patient underwent successful device implantation, activation, and use without disruption throughout electroconvulsive therapy sessions. No special device deactivation was required during electroconvulsive therapy sessions. CONCLUSION: Obstructive sleep apnea is a common disorder that causes significant reduction in quality of life and is an independent risk factor for multiple comorbidities. Electroconvulsive therapy is an established treatment for medication-refractory depression with minimal risk in most patient populations. This is the first report in the literature of a patient undergoing ECT for bipolar depression with recent activation of Inspire hypoglossal nerve stimulator who had no disruption in the function of his implanted device.

A naturalistic comparison of two right unilateral electroconvulsive therapy dosing protocols: 2-3X seizure threshold versus fixed high-dose.

The aim of this study was to compare the outcomes associated with two differing right unilateral (RUL) electroconvulsive therapy (ECT) dosing protocols: 2-3X seizure threshold (2-3X ST) and fixed high dose (FHD) at 353 mC. A retrospective chart review was performed to compare patient outcomes during the implementation of two different dosing protocols: 2-3X ST from October 2000 to May 2001 and FHD from June 2001 to February 2002. A total of 56 patients received ECT under the 2-3X ST protocol, and 46 received ECT under the FHD protocol. In total, 13.6% of patients receiving ECT according to the 2-3X ST protocol received more than 12 ECT, whereas none of the FHD group received more than 12 ECT. The mean number of ECT per treatment course reduced significantly from 7.6 to 5.7 following the switch from the 2-3X ST protocol to the FHD protocol. There were no significant differences between the two groups in the incidence of adverse cognitive effects. ECT practitioners adhered to the 2-3X ST protocol for only 51.8% of ECT courses, with protocol adherence improving to 87% following introduction of the FHD protocol. Although this naturalistic retrospective chart survey had significant methodological limitations, it found that practitioners are more likely to correctly adhere to a fixed dose protocol, therefore, increasing its 'real world' effectiveness in comparison to titrated suprathreshold dosing techniques. The FHD protocol was associated with shorter courses of ECT than the 2-3X ST protocol, with no significant difference between the two protocols in clinically discernable adverse cognitive effects.

Repetitive transcranial magnetic stimulation and electroconvulsive therapy: complementary or competitive therapeutic options in depression?

OBJECTIVE: To examine issues pertaining to the potential clinical roles of repetitive transcranial magnetic stimulation (rTMS) and the relationship of these to the use of electroconvulsive therapy (ECT). METHODS: A review of studies was carried out comparing the use of rTMS and ECT, with consideration of issues relating to the populations in which rTMS may be applied. RESULTS: There have been a number of randomized comparisons of rTMS and ECT. There are limitations with these studies, but in general they indicate that in non-psychotic patients rTMS appears to have a similar rate of response to ECT and certainly seems to have meaningful clinical effects. There are a number of clinical subpopulations in whom rTMS, but not ECT, is suitable, and assessment of the effectiveness of TMS in these populations is required. CONCLUSIONS: Repetitive TMS and ECT are likely to prove to be complementary clinical tools and the introduction of clinical programmes with rTMS will enhance patient options rather than replace the use of ECT.

A comparison of standard alternating current and low-energy brief-pulse electrotherapy.

This study compares a low-energy brief-pulse stimulus (LEBS) with a conventional a-c sine wave stimulus in terms of electrical paramenters, efficiency in producing seizures, and clinical outcome on a variety of standard behavioral measures. The results show the LEBS to require equal voltage, less current, and only one-half the total energy to produce clinically manifest convulsions. There was no apparent difference between methods on any outcome measure. The Halstead-Reitan Neuropsychological Test Battery showed as many patients impaired prior to ECT as following treatment. Implications for ECT practices are discussed.