Cognitive and Neurophysiological Recovery Following Electroconvulsive Therapy: A Study Protocol
Ben J Palanca, Hannah R. Maybrier, Angela M. Mickle, Nuri B Farber, R. Edward Hogan, Emma R. Trammel, J. Wylie Spencer, Donald D. Bohnenkamp, Troy S. Wildes, Shinung Ching, Eric J Lenze, Mathias Basner, Max B Kelz, Michael S. Avidan
Frontiers in Psychiatry May 14, 2018 DOI: 10.3389/fpsyt.2018.00171 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Randomized controlled trial Peer reviewed |
|---|---|
| Sample size | 15 |
| Population | Patients with major depressive disorder refractory to pharmacologic therapy |
| Interventions | etomidate + ECT ketamine + ECT ketamine + sham ECT |
| Topics | Depression Ketamine |
| Keywords | Electroconvulsive therapy Electroencephalography Anesthesia Seizures |
| Citations | 16 |
| Registration | NCT02761330 NCT01911195 |
| Key findings | The study will determine whether ketamine plus ECT prolongs time to return of responsiveness and cognitive recovery compared with ketamine plus sham ECT, and whether postictal delirium is linked to delayed cognitive restoration. |
Abstract
Electroconvulsive therapy (ECT) employs the elective induction of generalizes seizures as a potent treatment for severe psychiatric illness. As such, ECT provides an opportunity to rigorously study the recovery of consciousness, reconstitution of cognition, and electroencephalographic (EEG) activity following seizures. Fifteen patients with major depressive disorder refractory to pharmacologic therapy will be enrolled (Clinicaltrials.gov, NCT02761330). Adequate seizure duration will be confirmed following right unilateral ECT under etomidate anesthesia. Patients will then undergo randomization for the order in which they will receive three sequential treatments: etomidate + ECT, ketamine + ECT, and ketamine + sham ECT. Sessions will be repeated in the same sequence for a total of six treatments. Before each session, sensorimotor speed, working memory, and executive function will be assessed through a standardized cognitive test battery. After each treatment, the return of purposeful responsiveness to verbal command will be determined. At this point, serial cognitive assessments will begin using the same standardized test battery. The presence of delirium and changes in depression severity will also be ascertained. Sixty-four channel EEG will be acquired throughout baseline, ictal, and postictal epochs. Mixed-effects models will correlate the trajectories of cognitive recovery, clinical outcomes, and EEG metrics over time. This innovative research design will answer whether: (1) time to return of responsiveness will be prolonged with ketamine + ECT compared with ketamine + sham ECT; (2) time of restoration to baseline function in each cognitive domain will take longer after ketamine + ECT than after ketamine + sham ECT; (3) postictal delirium is associated with delayed restoration of baseline function in all cognitive domains; and (4) the sequence of reconstitution of cognitive domains following the three treatments in this study is similar to that occurring after an isoflurane general anesthetic (NCT01911195). Sub-studies will assess the relationships of cognitive recovery to the EEG preceding, concurrent, and following individual ECT sessions. Overall, this study will lead the development of biomarkers for tailoring the cogno-affective recovery of patients undergoing ECT.
Comparable studies
Other randomized controlled trials on ketamine for depression, most cited first.