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[femaledragon]

as usual i am obsessing over ECT. this week i have been wondering how ECT works with patients who are epileptic.

can someone please explain to me why it would be acceptable to give electroshock treatments, thereby purposely inducing seizures, in epileptic patients? could this be very harmful to such patients? could it make their epilepsy worse?

and even more important to me...if they are epileptic, don't you think that they have enough seizures on their own to achieve the treatment goal/behavioral modification? especially years ago, when we did not have effective medications, treatments and surgeries for epilepsy?

you would think the epileptics would be the happiest, gayest, smiliest, bunch of patients there ever were, if seizures were such effective means of psychiatric treatment.

one of my best friends is epileptic, and also regularly depressed. i have been with her times when she was having 20-30 grand mal seizures in a week. after witnessing what that has done to her, i have developed various feelings about epilepsy, treatment of epileptics, and also about ECT. i wonder how many seizures she has had in her life (she became epileptic at 13 years old, and she is now 38.) she  has received substandard medical care (medicare/disability) most of these years, so i imagine her number of G.M. seizures per year would be quite high.

if ECT is so useful and effective, wouldn't she be my cheeriest friend of all?

so as you see, i have been pondering a bit this week. i am interested to hear about ECT and epileptics. and also interested to hear what a pro-ECT health care provider would say about my musings over "happy happy epileptics."

thanks everyone.

[Lynne]

http://www.netdoctor.co.uk/diseases/depression/electroconvulsivetherapy_000605.htm

http://neuro.psychiatryonline.org/cgi/content/full/17/1/20

http://cat.inist.fr/?aModele=afficheN&cpsidt=15115411

http://ajgponline.org/cgi/content/abstract/6/2/180

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uids=16876485&query_hl=2&itool=pubmed_docsum

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uids=15970556&query_hl=2&itool=pubmed_docsum

http://jnnp.bmjjournals.com/cgi/content/full/76/suppl_1/i45

[femaledragon]

wow, Lynne, you are truly amazing. this will keep me busy all weekend. i may have questions after going through them all, if you don't mind.

[femaledragon]

wow, Lynne, the second link is intriguing. never realized so many things about epileptics and depressions and treatments. i plan to talk to my friend. i hadn't realized that some meds made her more likely to have seizures. we have switched her seizure meds so many times over the years, i have to wonder if he seizure meds are battling with her anti-depressants.

this shocked me to read, but i need to see more. this was in the second link

"Interestingly, the use of electroconvulsive therapy (ECT) is not contraindicated in epileptics and should be considered in patients with severe, treatment-resistant depression and sometimes can also be useful with manic episodes. The incidence of seizures after ECT is not increased in epileptics as compared to patients without a history of epilepsy.  Several studies demonstrated that ECT increases the convulsive threshold by 50%–100%. There are also reports of successful treatment of seizures by ECT in epileptics who did not respond to various antiepileptic drugs. ECT is therefore a treatment option for epileptics with treatment-resistant depression."

[femaledragon]

ok, i have now read all the articles and have some questions.

how different are the seizures caused by an ECT unit from those an epileptic patient would naturally have? why couldn't we just take them off their meds and supervise them and wait til they had their own natural seizure, and skip the terror and expense/time of a electric procedure?

and what would be the difference in brain damage from the two type of seizures?
is the brain damage and cerebral hemorraging that is sometimes seen in post-mortem studies of patients who had ECT more related to the destruction caused by the electric charge passign through the tissue? or would we find similar damage in untreated epileptics?

i find this all so confusing. and it seems the researchers are a bit stumped themselves.

thanks.