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首页> 外文期刊>The journal of ECT >Is There Evidence That Stimulus Parameters and Electrode Placement Affect the Cognitive Side Effects of Electroconvulsive Therapy in Patients With Schizophrenia and Schizoaffective Disorder? A Systematic Review
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Is There Evidence That Stimulus Parameters and Electrode Placement Affect the Cognitive Side Effects of Electroconvulsive Therapy in Patients With Schizophrenia and Schizoaffective Disorder? A Systematic Review

机译：是否有证据表明刺激参数和电极放置会影响精神分裂症和血症疾病患者的电耦合治疗的认知副作用？ 系统评价

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Seventy percent of patients with treatment-resistant schizophrenia do not respond to clozapine. Electroconvulsive therapy (ECT) can potentially offer significant benefit in clozapine-resistant patients. However, cognitive side effects can occur with ECT and are a function of stimulus parameters and electrode placements. Thus, the objective of this article is to systematically review published clinical trials related to the effect of ECT stimulus parameters and electrode placements on cognitive side effects. We performed a systematic review of the literature up to July of 2020 for clinical studies published in English or German examining the effect of ECT stimulus parameters and/or electrode placement on cognitive side effects in patients with schizophrenia or schizoaffective disorder. The literature search generated 3 randomized, double-blind, clinical trials, 1 randomized, nonblinded trial, and 1 retrospective study. There are mixed findings regarding whether pulse width and stimulus dose impact on cognitive side effects. One study showed less cognitive side effect for right unilateral (RUL) than bitemporal (BT) electrode placement, and 2 studies showed a cognitive advantage for bifrontal (BF) compared with BT ECT. Only 1 retrospective study measured global cognition and showed post-ECT cognitive improvement with all treatment modalities using Montreal Cognitive Assessment in comparison to pre-ECT Montreal Cognitive Assessment scores. Current data are limited, but evolving. The evidence suggests that RUL or BF ECT have more favorable cognitive outcomes than BT ECT. Definitive larger clinical trials are needed to optimize parameter and electrode placement selection to minimize adverse cognitive effects.
机译：70%的难治性精神分裂症患者对氯氮平无反应。电休克疗法（ECT）可能对氯氮平耐药患者有显著的益处。然而，ECT可能会产生认知副作用，并且是刺激参数和电极放置的函数。因此，本文的目的是系统地回顾已发表的与ECT刺激参数和电极放置对认知副作用的影响相关的临床试验。我们对截至2020年7月的文献进行了系统回顾，以英文或德文发表临床研究，研究ECT刺激参数和/或电极放置对精神分裂症或分裂情感障碍患者认知副作用的影响。文献检索产生了3项随机、双盲临床试验、1项随机、非盲试验和1项回顾性研究。关于脉冲宽度和刺激剂量是否会影响认知副作用，有不同的发现。一项研究表明，右侧单侧（RUL）的认知副作用小于双颞（BT）电极放置，两项研究表明双额（BF）与BT ECT相比具有认知优势。只有1项回顾性研究测量了整体认知，并显示了所有治疗方式下使用蒙特利尔认知评估（Montreal cognitive Assessment）与ECT前的蒙特利尔认知评估分数相比，ECT后认知改善。目前的数据有限，但在不断发展。证据表明，RUL或BF ECT比BT ECT有更有利的认知结果。需要进行明确的大型临床试验，以优化参数和电极放置选择，从而将不良认知影响降至最低。

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