Posted by Scott L. Schofield on February 7, 2000, at 22:06:11
In reply to Aphasia following ECT, posted by Chris A. on January 31, 2000, at 0:39:19
> I am trying to decide whether to continue ECT. After my unilateral treatment Friday I couldn't speak for two to three hours (not an airway or laryngyl problem). It was scary, but I don't know which to be more scared of - the possibility of not being able to talk or the suicidal depression. If anyone has info I'd appreciate some input so that I can make a more informed decision.
I noticed your post regarding aphasia, and was interested to read about your experiences with ECT, seeing as how I have undergone a course of treatments myself. I did not experience an aphasic reaction, but I was interested to see if this sort of thing has been reported on Medline. It appears to me that an episode of aphasia following an ECT treatment can indeed occur. However, it seems that this phenomenon is only transient. Dysphasia and aphasia occur when the dominant hemisphere (usually the left) is treated. My guess is that both unilateral-left and bilateral treatments could cause the same effects.Opponents of ECT believe that it causes brain damage. The use of the term "brain damage" indicates to me that the effects are deemed irreversible rather than transient. Among the effects claimed to arise from ECT are permanent memory loss, severe confusion, cognitive impairment, and aphasia. Personally, I have not found any source of these ideas to be at all credible.
I think your post-treatment aphasic episode warrants serious enough consideration to re-evaluate whether or not to continue with ECT. You and your doctor have some talking to do. I think if I were in your position (assuming that ECT is being used as some sort of last resort or has otherwise been determined to be the treatment of choice), I would ask my doctor to consult an expert of ECT with a great deal of clinical experience, or to recommend one.
I have included below just about all I could find on Medline on this topic. It's hard to decide very much based on less than a handful of entries. However, among them is a report regarding a patient who had a preexisting case of high blood-pressure. She developed aphasia following a unilateral ECT treatment of the *right* (non-dominant) hemisphere. It was determined that this was caused by a sort of "mini" stroke. If you have hypertension (high blood-pressure), you would obviously want to take that into consideration.
I hope something here is helpful to you in making any decisions, but I fear it may do just the opposite. At least you have a basis for your experiences and concerns.
- Scott
----------------------------------------------------
Neurol Neurosurg Psychiatry 1978 Dec;41(12):1135-44Neurological asymmetries immediately after unilateral ECT.
Kriss A, Blumhardt LD, Halliday AM, Pratt RT
Twenty-nine right handed patients were examined neurologically before and immediately after each of 62 unilateral ECTs to the dominant and non-dominant hemispheres. Most convulsions were followed by signs of transitory neurological dysfunction referable to the treated hemisphere. These signs included deep tendon reflex asymmetry, hemiparesis, tactile and visual inattention, and homonymous hemianopia. After treatment to the right hemisphere some patients had left visuospatial neglect, while all patients who had dominant hemisphere ECT were transiently dysphasic. All neurological abnormalities tested resolved within 20 minutes of treatment.PMID: 731257, UI: 79090259
---------------------------------------------------J Neurol Neurosurg Psychiatry 1981 Mar;44(3):193-6
The significance of laterality effects.
Warrington EK, Pratt RT
Language laterality can be unequivocally ascertained by comparing the effects of unilateral ECT to the right and the left hemisphere. It has been shown in right-handed depressed patients that a unilateral treatment to the left hemisphere resulted in transient dysphasia whereas unilateral ECT to the right hemisphere did not. The language laterality in a small group of left-handed depressed patients has been ascertained. Evidence is presented to show that neither dichotic listening nor hand position for writing provide satisfactory indices of language laterality. The ear advantage was more closely related to strength of sinistrality than to language laterality--that is sidedness appears to overide brainedness. The results favour a spatial attention hypothesis rather than a structural hypothesis as the main determinant of laterality effects.PMID: 7229640, UI: 81193684
---------------------------------------------------J ECT 1998 Mar;14(1):42-8
Reversible ischemic neurologic deficit after ECT.
Miller AR, Isenberg KE
Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri, USA.We report the case of a 58-year-old woman with depression and hypertension in whom aphasia, right-sided hemiparesis, and a possible right visual field defect were identified during recovery from right unilateral electroconvulsive therapy (ECT). The neurologic deficits resolved over a 3-day period; the patient was diagnosed with a reversible ischemic neurologic deficit (RIND). Review of the patient literature suggests that such cerebrovascular events in the setting of ECT are extremely rare and possibly decreasing in frequency. Reasons for such a decrease may include improved screening for predisposing cardiovascular conditions and the widespread use of neuromuscular blockade, ventilatory support, and cardiovascular monitoring during the procedure. Prompt recognition of cerebrovascular events is important to prevent complications such as cerebral edema, seizures, and aspiration, as well as to use new treatments for stroke.
Publication Types:
Clinical trial
Randomized controlled trial
PMID: 9661093, UI: 98325534--------------------------------------------------------------
poster:Scott L. Schofield
thread:20156
URL: http://www.dr-bob.org/babble/20000128/msgs/20727.html