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Case Report
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| A case of schizophrenia successfully treated by m-ECT using 'long' brief pulse |
| Hiroaki Inomata1, 2, Hirohiko Harima1, Masanari Itokawa1 |
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1Department of Psychiatry, Tokyo Metropolitan Matsuzawa Hospital, 2-1-1 Kamikitazawa, Setagaya-ku, Tokyo, Japan.
2PHAZOR, LLC, Yokohama, Japan. |
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doi:10.5348/ijcri-2012-07-147-CR-8
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Address correspondence to: Hiroaki Inomata Department of Psychiatry, Tokyo Metropolitan Matsuzawa Hospital 2-1-1 Kamikitazawa, Setagaya-ku Tokyo Japan - 156-0057 Phone: +81-3-3303-7211 Fax: +81-3-3329-7586 Email: inomatah0612@gmail.com |
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| How to cite this article: |
| Inomata H, Harima H, Itokawa M. A case of schizophrenia successfully treated by m-ECT using 'long' brief pulse. International Journal of Case Reports and Images 2012;3(7):30–34. |
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Abstract
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Introduction:
Modified-Electroconvulsive Therapy (m-ECT) is administered for the treatment of various psychiatric disorders. The Seizure Generalization Hypothesis holds that propagation of the induced seizure throughout the entire brain is essential for effective ECT intervention. However, there are many clinical cases where, due to high thresholds, seizure is not induced by the maximum dose of electrical charge. Several studies have indicated that the ultrabrief pulse method, in which the pulse width is less than 0.5 millisecond (ms), is more effective for inducing seizures than the conventional brief pulse (0.5-2.0 ms).
Case Report: A 35-year-old Japanese male schizophrenic with psychomotor excitement was admitted to our hospital. In a series of m-ECT interventions, trials with 1.0 and 1.5 ms width pulses (referred to as 'long' brief pulse as 0.5 ms width pulse is the default in Japan) succeeded in inducing seizures, whereas the ultrabrief pulse failed. Conclusion: This case suggests that seizure threshold depends on pulse width. We speculate that in our patient the strength-duration curve involved in ECT-induced seizures might be right-shifted resulting in prolonged chronaxie to about 1.0 ms. Therefore, in cases where neither the default width pulse nor the ultrabrief pulse induces seizures, patients should be considered for treatment using a wider width pulse. | |
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Key Words:
Electroconvulsive Therapy, Pulse width, Chronaxie, Schizophrenia
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Author Contributions:
Hiroaki Inomata - Substantial contributions to conception and design, Acquisition of data, Analysis and interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published Hirohiko Harima - Acquisition of data, Revising it critically for important intellectual content, Final approval of the version to be published Masanari Itokawa - Analysis and interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published |
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Guarantor of submission:
The corresponding author is the guarantor of submission. |
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Source of support:
None |
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Conflict of interest:
Authors declare no conflict of interest. |
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Copyright:
© Hiroaki Inomata et al. 2012; This article is distributed the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any means provided the original authors and original publisher are properly credited. (Please see Copyright Policy for more information.) |
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