2023-11-27 15:10:10
Seismotherapy, also called electroconvulsive therapy (ECT), is in some ways the modern equivalent of electroshock treatments, administered in the 1930s. It is prescribed as a last intention in the context of depression or psychiatric pathologies resistant to usual treatments. What exactly does it consist of? We take stock with Dr Charles Laidi, psychiatrist and teacher-researcher at the Inserm laboratory “Mondor Institute of Biomedical Research.
Definition: what is seismotherapy?
Seismotherapy consists of inducing an epileptic attack under general anesthesia, using a brief, weak electrical current transmitted through the skull. More concretely, the medical team places two electrodes at the patient’s temples: which allows the alternating current to pass through his skull. Said patient is therefore subject to a painless convulsive attack, with therapeutic effects. Its main advantages are the speed of action and the lower occurrence of side effects. Furthermore, it is integrated into the treatment of numerous psychological and psychiatric disorders.
Although it has spread in France – and in the West – since the beginning of the 1930s, it has long suffered from a bad reputation. In question ? Side effects linked to electroshock and abusive practices publicized at the end of the Second World War. Not counting the democratization of psychotropic drugs (antipsychotics and neuroleptics). But at the end of the 90s, to guarantee the smooth running of the sessions, the French Society of Anesthesia and Resuscitation and the French Federation of Psychiatry therefore drafted recommendations for good practices, under the aegis of the National Agency for Psychiatry. health accreditation and assessment (Anaes).
On what principle does it work?
By reflex, when subjected to a convulsive attack, the brain secretes neurotransmitters and neurohormones (dopamine, norepinephrine, serotonin, etc.) involved in various mood disorders. These substances thus stimulate neurons and promote the creation of new neuronal connections.
Depression, bipolar disorder, schizophrenia… When to do seismotherapy?
As recalled by the Institute for Research and Documentation in Health Economics in a report published in April 2022, this procedure is highly effective in the management of mood disorders resistant to traditional treatments (medications and psychotherapy):
- depression ;
- syndrome catatonique
- et some forms of bipolar disorder.
Seismotherapy is also indicated in certain forms of schizophrenia. Indications also exist outside the field of psychiatry for degenerative diseases with behavioral disorders, such as Parkinson’s disease, Gilles de la Tourette syndrome or even certain obsessive-compulsive disorders (OCD).
Who prescribes seismotherapy? Where to do the sessions?
Electroconvulsive therapy necessarily involves informed consent of the patient. It is only considered as a last resort, after in-depth examination and complete assessment of the advantages and disadvantages, in the event of:
- drug resistance (therapeutic failure of several psychotropic drugs at different dosages);
- short-term vital prognosis (dehydration, malnutrition, neuro-vegetative abnormalities, etc.);
- pathologies incompatible with other treatments – or pregnancy (due to teratogenic effects);
- good previous response to seismotherapy;
- and suicide risk.
The sessions are administered by a psychiatrist, an anesthetist and nurses, but not all establishments practice seismotherapy. “ECT requires an adequate technical platform, which cannot always be set up within the hospital itself providing psychiatric monitoring which then organizes the transfer of patients to an establishment with the necessary technical resources,” specifies the Institute for Research and Documentation in Health Economics (source 1).
How many ECT sessions are needed?
Curative treatment generally involves 12 to 20 sessions (at the rate of two to three weekly sessions). “In the case of emergency treatments linked to a life-threatening situation, the treatment may stop as soon as signs of seriousness disappear such as catatonic characteristics, a state of agitation or a suicidal crisis”, specifies the Institute for Research and Documentation in Health Economics. A maintenance or maintenance treatment can also be administered to prevent relapse and then includes sessions spaced one month apart which can be carried out on an outpatient basis. In summary, the number of sessions varies from one patient to another, depending on the severity of their pathology and its reception. The medical condition of the patients is therefore regularly evaluated by the medical team.
How does a seismotherapy session work?
Electroconvulsive therapy sessions are carried out in hospital, in an outpatient department or as part of a longer hospitalization. They are provided by a psychiatrist, assisted by an anesthetist and nurses. A prior consultation also takes place with the anesthetist to rule out any contraindication to general anesthesia.
On the big day, the patient presents with an empty stomach. He is placed on perfusion and monitoring. An electroencephalogram also reports the state of his brain, and makes it possible to follow the evolution of the epileptic seizure. The patient is then placed under General anaesthesia. Then the anesthesiologist administers an injection of curarewhich helps limit excessive muscle convulsions.
Once this is in place, it is up to the psychiatrist to administer the electroshocks using electrodes implanted on either side of the brain (at the temples). The convulsive seizure does not last no more than 30 seconds. The patient is then transferred to the recovery room for close monitoring for three to four hours. He wakes up between 10 and 30 minutes after the attack. Then, depending on the terms of his care, he can either return home or join the department in which he is hospitalized. In this case, he must be accompanied and monitored by a third person for almost 24 hours.
Electroconvulsive therapy: what are the side effects and contraindications?
The most common side effects of ECT must be clearly explained to the patient: headaches, confusion, memory problems and executive function problems. They are fortunately transient.
More rarely, we can observe mechanical injuries at the level of the teeth, shoulders or vertebrae when the curarization was not sufficient and did not make it possible to immobilize the patient.
Finally, the mortality associated with this treatment is rare and comparable to that of general anesthesia for minor surgical procedures (1 per 10,000 patients treated or 2 per 100,000 sessions).
The only absolute contraindication to this treatment is intracranial hypertension. (the administration of electroshocks in fact increases the tension inside the skull). Without forgetting the contraindications linked to general anesthesia, which are discussed in advance by the medical team.
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