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首页> 外文期刊>The journal of ECT >Flumazenil pretreatment in benzodiazepine-free patients: A novel method for managing declining ECT seizure quality
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Flumazenil pretreatment in benzodiazepine-free patients: A novel method for managing declining ECT seizure quality

机译:不含苯二氮卓类药物的氟马西尼预处理:一种控制ECT癫痫发作质量下降的新方法

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摘要

Objective: Seizure threshold increases with successive electroconvulsive therapy (ECT) treatments, which can be especially problematic when treating older patients who have higher seizure thresholds at baseline because ECT devices are limited by the amount of charge that can be delivered. Case Reports: We present a case series of 3 older patients who had long ECT courses that were complicated by inability to generate seizures, poor quality seizures, and inadequate clinical response despite established measures to lower seizure threshold including prehydration, hyperventilation, and minimizing methohexital dose using remifentanil. As preclinical studies show electroconvulsive seizure increases diazepam binding, we hypothesized that a contributor to declining seizure quality and inadequate ECT responsiveness in these individuals was enhanced benzodiazepine receptor function, although none of the 3 patients were taking benzodiazepines or any other anticonvulsant medication. Accordingly, we pretreated patients with flumazenil, a competitive inhibitor at the benzodiazepine-binding site, and observed improvement in seizure quality and clinical response. Conclusion: Flumazenil pretreatment of elderly ECT patients with declining seizure quality and inadequate clinical response in the setting of repeated treatments may represent a novel strategy for managing such patients. A clinical trial would be required to test this hypothesis.
机译:目的:癫痫发作阈值会随着连续电惊厥疗法(ECT)的治疗而增加,这在治疗基线时癫痫发作阈值较高的老年患者时尤其成问题,因为ECT装置受到可输送电荷的限制。病例报告:我们提供了一个3例老年患者的病例系列,这些患者的ECT病程长,尽管已制定了降低癫痫发作阈值的措施,包括预充水,过度换气和最大程度地降低了甲氧西他汀剂量,但这些疾病并没有引起癫痫发作,质量较差的癫痫发作和临床反应不足使用瑞芬太尼。临床前研究表明,惊厥性癫痫发作增加了地西epa的结合,我们假设尽管三例患者均未服用苯二氮卓类药物或任何其他抗惊厥药物,但这些患者癫痫发作质量下降和ECT反应不足的原因是苯二氮卓受体功能增强。因此,我们用氟马西尼(一种在苯二氮卓结合位点的竞争性抑制剂)对患者进行了预处理,并观察到癫痫发作质量和临床反应均有改善。结论:氟马西尼预处理老年癫痫患者的癫痫发作质量下降且临床反应不足,可能是重复治疗的一种新策略。需要进行临床试验以检验该假设。

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