Does ECT alter brain structure?
Does ECT alter brain structure?
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ECT 会改变大脑结构吗？
DOI：
10.1176/ajp.151.7.957
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发表时间：
1994
期刊：
影响因子：
--
通讯作者：
Sackeim,HA
中科院分区：
文献类型：
--
作者：
Devanand,DP;Dwork,AJ;Hutchinson,ER;Bolwig,TG;Sackeim,HA
目的本研究的目的是评估ECT是否会造成结构性脑损伤。方法文献综述涵盖以下领域：认知副作用、结构性脑成像、接受ECT患者的尸检、癫痫受试者的尸检、电惊厥休克（ECS）和癫痫的动物研究，以及电、热产生和血脑的神经病理学影响。 屏障破坏。结果 ECT 引起的认知缺陷是暂时的，尽管 ECT 过程周围发生的事件可能会持续出现点状记忆丧失。前瞻性计算机断层扫描和磁共振成像研究表明没有证据表明 ECT 引起的结构变化。未经修改的 ECT 时代的一些早期人体尸检病例报告报告了由于临终变化或未确诊疾病引起的脑血管病变。在动物 ECS 研究中，使用与人类 ECT 相当的刺激强度和频率，当采用适当的对照动物、盲法和灌注固定技术时，没有发现神经元损失。即使在长期 ECS 疗程后，使用定量细胞计数的对照研究也未能显示神经元损失。几项对照良好的研究表明，灵长类动物仅在持续癫痫发作 1.5 至 2 小时后才会发生神经元损失，而充分的肌肉麻痹和氧合会进一步延迟这些变化。 ECT 期间不会达到这些条件。其他研究结果表明，ECS 期间的电流传递、热效应和血脑屏障的短暂破坏不会导致结构性脑损伤。结论没有可靠的证据表明 ECT 会导致结构性脑损伤。
ObjectiveThe purpose ofthis study was to evaluate whether ECT causes structural brain damage.MethodThe literature review covered the following areas: cognitive side effects, structural brain imaging, autopsies of patients who had received ECT, post-mortem studies of epileptic subjects, animal studies of electroconvulsive shock (ECS) and epilepsy, and the neuropathological effects ofthe passage ofelectricity, heat generation, and blood-brain barrier disruption.ResultsECT-induced cognitive deficits are transient, although spotty memory loss may persist for events immediately surrounding the ECT course. Prospective computerized tomography and magnetic resonance imaging studies show no evidence ofECT-induced structural changes. Some early human autopsy case reports from the unmodified ECT era reported cerebrovascular lesions that were due to agonal changes or undiagnosed disease. In animal ECS studies that used a stimulus intensity and frequency comparable to human ECT, no neuronal loss was seen when appropriate control animals, blind ratings, and perfusion fixation techniques were employed. Controlled studies using quantitative cell counts have failed to show neuronal loss even after prolonged courses ofECS. Several well-controlled studies have demonstrated that neuronal loss occurs only after 1.5 to 2 hours ofcontinuous seizure activity in primates, and adequate muscle paralysis and oxygenation further delay these changes. These conditions are not approached during ECT. Other findings indicate that the passage of electricity, thermal effects, and the transient disruption ofthe blood-brain barrier during ECS do not result in structural brain damage.ConclusionsThere is no credible evidence that ECT causes structural brain damage.