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Focal Electrically Administered Seizure Therapy (FEAST): A novel form of ECT illustrates the roles of current directionality polarity and electrode configuration in seizure induction

机译：局部电管理性癫痫发作治疗（FEAST）：ECT的一种新颖形式说明了电流方向性极性和电极配置在癫痫发作诱导中的作用

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Electroconvulsive therapy (ECT) is a mainstay in the treatment of severe, medication resistant depression. The antidepressant efficacy and cognitive side effects of ECT are influenced by the position of the electrodes on the head and by the degree to which the electrical stimulus exceeds the threshold for seizure induction. However, surprisingly little is known about the effects of other key electrical parameters such as current directionality, polarity, and electrode configuration. Understanding these relationships may inform the optimization of therapeutic interventions to improve their risk/benefit ratio. To elucidate these relationships, we evaluated a novel form of ECT (focal electrically administered seizure therapy, FEAST) that combines unidirectional stimulation, control of polarity, and an asymmetrical electrode configuration, and contrasted it with conventional ECT in a nonhuman primate model. Rhesus monkeys had their seizure thresholds determined on separate days with ECT conditions that crossed the factors of current directionality (unidirectional or bidirectional), electrode configuration (standard bilateral or FEAST (small anterior and large posterior electrode)), and polarity (assignment of anode and cathode in unidirectional stimulation). Ictal expression and post-ictal suppression were quantified via scalp EEG. Findings were replicated and extended in a second experiment with the same subjects. Seizures were induced in each of 75 trials, including 42 FEAST procedures. Seizure thresholds were lower with unidirectional than with bidirectional stimulation (p<0.0001), and lower in FEAST than in bilateral ECS (p=0.0294). Ictal power was greatest in posterior-anode unidirectional FEAST, and post-ictal suppression was strongest in anterior-anode FEAST (p=0.0008 and p=0.0024, respectively). EEG power was higher in the stimulated hemisphere in posterior-anode FEAST (p=0.0246), consistent with the anode being the site of strongest activation. These findings suggest that current directionality, polarity, and electrode configuration influence the efficiency of seizure induction with ECT. Unidirectional stimulation and novel electrode configurations such as FEAST are two approaches to lowering seizure threshold. Furthermore, the impact of FEAST on ictal and post-ictal expression appeared to be polarity-dependent. Future studies may examine whether these differences in seizure threshold and expression have clinical significance for patients receiving ECT.
机译：电抽搐疗法（ECT）是治疗严重的药物耐受性抑郁症的主要手段。 ECT的抗抑郁功效和认知副作用受电极在头上的位置以及电刺激超过癫痫发作诱发阈值的程度的影响。但是，令人惊讶的是，对其他关键电参数（例如电流方向性，极性和电极配置）的影响知之甚少。了解这些关系可能有助于优化治疗干预措施，以提高其风险/收益比。为了阐明这些关系，我们评估了一种新颖形式的ECT（局部电刺激性癫痫治疗，FEAST），该形式结合了单向刺激，极性控制和不对称电极配置，并将其与非人灵长类动物模型中的传统ECT进行了对比。恒河猴的癫痫发作阈值是在单独的日子通过ECT条件确定的，该条件与电流方向性（单向或双向），电极构型（标准的双侧或FEAST（前小电极和后大电极））和极性（阳极和阳极的分配）有关。阴极单向刺激）。通过头皮脑电图定量表达表达和抑制表达。在相同对象的第二个实验中，重复了发现并扩展了发现。 75项试验均诱发癫痫发作，包括42项FEAST程序。单向癫痫发作阈值低于双向刺激（p <0.0001），FEAST癫痫发作阈值低于双边ECS（p = 0.0294）。在阳极后向单向FEAST中，眼动功率最大，而在阳极前向FEAST中，后壁抑制最强（分别为p = 0.0008和p = 0.0024）。在后阳极FEAST中，受激半球的脑电图功率较高（p = 0.0246），这与阳极是最强激活位点一致。这些发现表明，电流方向性，极性和电极配置会影响ECT诱发癫痫发作的效率。单向刺激和新颖的电极配置（例如FEAST）是降低癫痫发作阈值的两种方法。此外，FEAST对牙齿和牙齿后表达的影响似乎与极性有关。未来的研究可能会检查癫痫发作阈值和表达的这些差异是否对接受ECT的患者具有临床意义。

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