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Electroconvulsive Therapy

Electroconvulsive Therapy

Electroconvulsive therapy (ECT), or shock therapy, remains a critical biomedical intervention for severe, treatment-resistant depression. While its origins can be traced back to Hippocrates' observations that malaria-induced convulsions alleviated mental illness, modern ECT has evolved significantly from its earlier, more primitive applications. First introduced in 1938 by Ugo Cerletti and his colleagues, ECT involves inducing controlled seizures using electrical currents. In its early...

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MRI-guided dmPFC-rTMS as a Treatment for Treatment-resistant Major Depressive Disorder

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Catatonia with schizophrenia: From ECT to rTMS.

E Stip¹, M-E Blain-Juste², O Farmer³

¹CHUM, Notre-Dame, Montréal, QC, Canada; Department of Psychiatry, University of Montréal, h2l 2w5 Montréal, QC, Canada; Neuromodulation unit, CHUM, Montréal, QC, Canada.

|December 16, 2017

Summary

Repetitive Transcranial Magnetic Stimulation (rTMS) offers a promising alternative for treating catatonic schizophrenia when other methods fail. This neuromodulation technique shows effectiveness in both acute and maintenance phases, especially when electroconvulsive therapy (ECT) poses safety concerns.

Keywords:

Brain stimulation Catatonia Catatonie Electroconvulsivotherapy Schizophrenia Schizophrénie Stimulation magnétique transcraienne Zolpidem(®)rTMS

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Area of Science:

Neurology
Psychiatry
Neuroscience

Background:

Electroconvulsive therapy (ECT) is a standard treatment for catatonic schizophrenia, particularly after pharmacologic interventions like lorazepam or Zolpidem fail.
Some patients require ongoing maintenance ECT, while newer neuromodulation techniques such as repetitive Transcranial Magnetic Stimulation (rTMS) and transcranial direct-current stimulation (tDCS) are being explored for catatonia.

Purpose of the Study:

To explore alternatives to electroconvulsive therapy (ECT) for patients with refractory catatonia.
To review the efficacy and application of repetitive Transcranial Magnetic Stimulation (rTMS) as a treatment for catatonic schizophrenia.

Main Methods:

A literature search was conducted on Medline, Google Scholar, PsychInfo, and CAIRNS using keywords such as 'catatonia', 'rTMS', 'ECT', and 'tDCS'.
The review focused on case reports detailing the use of rTMS and tDCS as alternatives to ECT for catatonia.
Six case reports on rTMS and three on tDCS were analyzed to discuss treatment strategies and outcomes.

Main Results:

High-frequency rTMS was identified as a potential alternative to ECT, especially for patients with comorbid epilepsy where chronic ECT poses risks.
rTMS treatment, administered 3-4 times weekly and later extended to bi-weekly, demonstrated persistent improvement in catatonia symptoms as measured by the Bush-Francis Catatonia Rating Scale.
While ECT was effective for some, including one patient with 556 sessions over 20 years, rTMS presented a viable option for those with safety concerns regarding long-term ECT.

Conclusions:

Repetitive Transcranial Magnetic Stimulation (rTMS) is effective for both acute and maintenance treatment of catatonic schizophrenia.
rTMS should be considered a potential treatment option for refractory catatonia, particularly when pharmacologic interventions have failed and there are safety concerns with continued maintenance ECT.