Development, validation and application of an seizure quality index for the predicting of remission after electroconvulsive therapy.

电休克治疗(ECT)是几种严重精神障碍的既定治疗选择。情感障碍的缓解率约为60%。这可能表明，患者和治疗本身的某些特性改变了抑郁症缓解的可能性。然而，这些参数只占差异的一部分。我们的观点是，ECT治疗中触发发作的质量也有可能解释这种差异的相关比例。全面性发作已被确认为ECT疗效的必要因素，但也表明，癫痫发作的疗效各不相同。已经进行了几项研究，以确定癫痫发作的特征，从而产生更好的疗效。这些研究大多只是初步的，缺乏适当的样本量，并以回溯性的方式进行分析。通常，只对一次癫痫发作测量进行分析，常规结果参数缺乏临床意义。在我们以前的工作中，我们建立了一个癫痫发作质量的模型，该模型是由几个单一的癫痫发作参数得出的，并且已经可以证明与治疗效果的相关性。然而，这个模型必须被认为是非常初步的，因为它的临界值只是粗略估计的，分类是基于临床经验的。此外，该模型既没有经过验证，也没有与缓解等临床相关结果参数相关联。这个项目的第一个目标是开发一个有效的癫痫发作质量指数(SQI)，它代表了ECT中癫痫发作的一般质量，是由癫痫发作的几个独立特征和协变量(如年龄)构成的。在第一步中，将汇集已经存在的回顾数据，并开发一个合理的模型，预测重度抑郁症患者临床缓解的可能性。第二步是一项前瞻性研究，它应该验证新的SQI模型预测缓解的能力。本项目的另一个目的是通过研究癫痫发作质量指数与外周脑源性神经营养因子(BDNF)、睡眠质量和认知副作用之间的关系来证明新型SQI的适用性。

Electroconvulsive therapy (ECT) is an established treatment option in several severe mental disorders. Remission rates are about 60% for affective disorders. It could be shown, that certain properties of both, the patient and the treatment itself modify the probability of remission in depression. However, these parameters only account for a proportion of the variance. Our opinion is that the quality of the triggered seizure within the ECT treatment has also the potential to account for a relevant proportion of this variance. The generalised seizure has been identified as the necessary element for the efficacy in ECT, but it has been shown also, that the efficacy of the seizures varies. Several studies have been conducted in order to identify characteristics of the seizure, which lead to a superior efficacy. Most of these studies are only preliminary, lack a proper sample size and were analysed in a retrospective way. Commonly, only one single seizure measurement was analysed and regularly outcome parameters lacked clinical significance. In our previous work we built a model for seizure quality, which was derived from several single seizure parameters and for which a correlation with treatment efficacy could already be demonstrated. However this model must be considered as very preliminary, because its cut-off values were only broadly estimated and the categories were classified based on clinical experience. Additionally neither the model was validated nor was it correlated with clinically relevant outcome parameters such as remission. The first aim of this project is the development of a validated - Seizure Quality Index - (SQI), which represents the general quality of a seizure in ECT and is built from several independent features of a seizure and covariates such as age. In the first step retrospective data that already exists will be pooled and a reasonable model that predicts the likelihood of a clinical remission for patients with major depression will be developed. The second step consists of a prospective study, which should validate the power of the new SQI model to predict remission. A further aim of the project is to demonstrate the applicability of the novel SQI by investigate the relations between the seizure quality index on the one hand and the peripheral brain-derived neurotrophic factor (BDNF), the sleeping quality and the cognitive side effects on the other hand.