Electroconvulsive therapy and side effects - a retrospective analysis at the Universitätsmedizin Göttingen

Electroconvulsive therapy is one of the most controversial discussed medical procedures of the 20 th and 21st century. On the one hand there have been well evaluated scientific studies on efficacy and safety for decades. On the other hand in public and media, stories of torture and punishment have been published. It was the aim of this work to determine all actual ECT related side effects (UAW) by retrospective medical sheet evaluation. For this purpose, all electroconvulsive therapies, which were available in the years 2010 to 2011 at the Universitätsmedizin Göttingen, were analyzed. During this period 1338 stimulations of 76 patients were recorded. The patient group consisted of 35 men and 41 women and was on average 54.82 years (SD 15.06) old. On average, patients received 17.61 ECT treatments (SD 12.54). The leading main diagnosis were the affective disorders (n=60 patients), followed by 12 patients with schizophrenic disorders, 2 patients with organic mental disorders and 2 patients with compulsive disorders. All adverse events related to ECT and documented in patients medical sheets were determined. Similarly, the general descriptive framework of ECT, like the energy set, placement of electrodes etc, as well as patients characteristics were determined. The UAW were classified and by statistical processing correlations between UAW and influences were analyzed. The present work could show significant correlations of UAW and patients characteristics (age, sex, diagnoses), stimulus parameters of ECT (charge delivered, lengths of convulsion, restimulation and placement of electrodes), the amount of muscle relaxant and psychopharmacological medication. On average, it lasted almost 10 years from initial diagnosis until patients received their first ECT. The present work could show that the amount of UAW increases significantly by longer period of illness and by increased number of implemented ECT. Drug-resistant patients, who need more ECT to reach remission, have not only to suffer under the severity of their psychiatric disorder, but also have to endure more UAW of ECT. The present work shows that 34% of all ECT were affected by UAW. The most common adverse events were monitoring in the recovery room (after 11% of all ECT), headache (after 10% of all ECT), fatigue (after 8,6% of all ECT) and short-term memory disorders (after 4,4% of all ECT). The determined UAW were classified in severity score 1 (headache, muscle soreness, fatigue, dizziness and nausea), severity score 2 (bronchospasm, disorientation, wetting, concentration disturbances, short-term memory disorders, postictal unrest) and severitys core 3 (asystole). The analyses showed that most UAW (67 %) were mild (severity score 1), less than one third of documented UAW (29 %) were from severity score 2 and less than 5 % were serious UAW (severity score 3). Furthermore, no ECT stimulation lead to vital thread. So this work confirms, according to today`s standards by using modern devices and performing a short anesthesia, that ECT is an extreme safe procedure with few side effects. One of the most frequently feared side effects of ECT are cognitive disorders. In the present work, these were noted in less than 7 % of the stimulations. Approximately 40% of all patients were affected at some time during treatment course. It is repeatedly discussed whether ECT is responsible for cognitive disorders, wether ECT worsens or improves them. The severity of a psychiatric disorder has been shown to affect the occurrence of memory disorders and in most patients, there is an improvement in the course of treatment. Correlations between the occurance of cognitive disturbances and stimulation parameters are known and could be confirmed in this work. For example, there could be recorded increased cognitive side effects in the case of charge doses in the high dose range. If patients are vulnerable, the possibility exists to adjust the stimulation to the most gently parameters. The relatively new placement of the LART-method shows a more favorable cognitive side effect profile than the traditional bitemporal positioning. It was noticeable that women were more frequently affected by many side effects than men. In this respect further studies are necessary to elucidate the causes of this clinically relevant phenomenon. Furthermore, there seems to be a need for research on the psychopharmacological medication with ECT. The effectiveness of ECT can be increased by concomitant pharmacological therapies. The present work could not clarify, whether ECT side effects were increased or reduced by concomitant pharmacological therapies. During the observation period, satisfactory quality parameters of ECT were found. On average the duration of seizure measured in EEG was 39,58 seconds (SD ± 22,17). The average seizure energy index, the maximum sustained power and the maximum sustained coherence showed satisfying results for most of the stimulations. In the future, the increase in heart rate as a quality parameter could also become established in clinical practice. In summary, it becomes clear, that on the one hand, patients still receive ECT very late or too late, and on the other hand, that this very effective therapy is only carried out when the disease itself has taken a severe course. At this point, it must be mentioned, that success rates of ECT decrease with longer persistent drug-resistant disease as well as any other form of therapy. Drug-resistant patients must promptly be informed about ECT as a treatment option. The present work can improve the perception of ECT as a safe therapy option with few side effects and may contribute to the further spread of this treatment.2017-03-1