Major Depresyon ve Psikotik Bozuklukta Elektrokonvülzif Tedavi Öncesi Çekilen EEG’nin Kantitatif İncelenmesinin Prognozdaki Rolü

Yıl 2013, Cilt: 20 Sayı: 1, 55 - 60, 01.02.2013

Ertugrul Dal⊃ Özden Kamışlı M.emin Tagluk Şükrü Kartalcı Yüksel Kaplan Cemal Özcan

Öz

Amaç: Bu çalışmada amacımız elektrokonvülzif tedaviden fayda görecek veya görmeyecek hastaları, elektrokonvülzif tedavi işlemi öncesi çekilecek elektroensefalografilerini inceleyerek önceden tahmin edebilmektir. Gereç ve Yöntemler: Bu çalışmaya psikotik bozukluk ve majör depresyon tanılı toplam 40 hasta alındı. Hastaların elektroensefalografileri elektrokonvülzif tedavi öncesi çekildi. Hastaların elektrokonvülzif tedaviden fayda görüp görmediği majör depresyonlu hastalarda tedavi öncesi ve 6-12 seanslık tedavi sonrası Hamilton depresyon ölçeği puanları ile psikotik hastalarda yine tedavi öncesi ve 6-12 seanslık tedavi sonrası pozitif ve negatif semptomları derecelendirme ölçekleri puanları ile değerlendirildi. Bulgular: Her elektrot işareti zaman ekseninde kayan genliği 1 ve T=500 örnek uzunluğunda bir pencere ile üst üste gelmeyecek şekilde pencerelenerek, her iki çift pencere arasındaki ilinti değerlendirildi. Global ve elektrot bazında oluşturulan bu endeks sonuçlarının iki grup arasında anlamlı bir fark oluşturmadığı görüldü. Her bir elektrot elektroensefalografi işaretlerinin alt bandı diğer elektrotlara ait aynı alt bant ilintisini alıp ve toplam ortalama ilinti gücünü temsil eden global bir endeks oluşturuldu ve değerlendirildi. Ayrıca sağ ve sol hemisferler arasındaki simetri indeksi değerlendirildi ancak anlamlı bir fark bulunamadı. Sonuç: Sonuç olarak elektrokonvülzif tedavi öncesi hastalardan çekilen elektroensefalografi analizinden hastanın elektrokonvülzif tedaviden fayda görüp görmeyeceği yapılan bu çalışma ile anlaşılamadı. Ancak bu olumsuz bulguyu standardize etmek için literatürde var olan tüm metotların denenmesi, belki de yeni metotlar geliştirip uygulamak faydalı olabilir. Anahtar kelimeler: Kantitatif EEG; Elektrokonvülzif Tedavi; Fourier Analizi.

Anahtar Kelimeler

Kantitatif EEG; Elektrokonvülzif Tedavi; Fourier Analizi.

Prognostic Value of Quantative EEG Prior to Electroconvulsive Therapy in Psychotic Disorders and Major Depression

Öz

Aim: Our aim is to predict the patients who may benefit from electroconvulsive therapy by examining quantative electroencephalographies' captured before the electroconvulsive therapy procedure. Meterial and Methods: A total of 40 patients with psychotic disorder or major depression were included in this study. Electroencephalographies were obtained before electroconvulsive therapy. The Hamilton depression scale scores of the patients with major depression and the positive and negative symptom rating scale scores of psychotic patients before and after 6-12 sessions of electroconvulsive therapy was used to determine whether electroconvulsive therapy was beneficial. Electroencephalography data were analyzed with the Fourier analysis method. Results: Every electrode signal recorded from the patient electroencephalography in Matlab environment was windowed with a window of sliding amplitude in time axis 1 and length of T=500. The correlation between two windows was quantified. Results generated on a global and electrode basis were observed to not show a significant difference between the two groups .The sub-band for the electroencephalography signals of each electrode and the correlation of the same sub-band belonging to other electrodes were acquired and a global index representing the total mean correlation power was calculated. The symmetry index between the right and left hemisphere in electroencephalographies was also not significant. Conclusion: In this study we were unable to determine whether a patient would benefit from electroconvulsive therapy using the Electroencephalography signals obtained prior to the treatment. The determination of whether such predictive parameters are of clinical utility for the prediction of outcome awaits further studies. Key words: Quantitative EEG; Electroconvulsive Therapy; Fourier Analysis.

Anahtar Kelimeler

Quantitative EEG; Electroconvulsive Therapy; Fourier Analysis.

Kaynakça

• Tomruk NB, Oral T. Elektrokonvulsif tedavinin klinik kullanımı: bir gözden geçirme. Anadolu Psikiyatri Derg 2007;8:302-9.
• Prudic J. Electroconvulsive therapy. In: Saddock BJ, Saddock VA Ruiz P, eds. Kaplan and Saddock’s Comprehensive Textbook of Psychiatry. 9th edition. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins; 2009. p. 3285-3301.
• Tudor M, Tudor L, Tudor KI. Hans Berger (1873-1941): the history of electroencephalography. Acta Med Croatica 2005;59:307-13.
• De Vreede IM, Burger H, van Vliet IM. Prediction of response to ECT with routinely collected data in major depression. J Affect Disord 2005;86:323-7.
• Oudega ML, van Exel E, Wattjes MP et al. White matter hyperintensities, medial temporal lobe atrophy, cortical atrophy, and response to electroconvulsive therapy in severely depressed elderly patients. J Clin Psychiatry 2011;72:104-12
• Chanpattana W, Sackeim HA. Electroconvulsive therapy in treatment-resistant schizophrenia: prediction of response and the nature of symptomatic improvement. J ECT 2010;26:289-98.
• Hickie I, Parsonage B, Parker G. Prediction of response to electroconvulsive therapy. Preliminary validation of a sign-based typology of depression.Br J Psychiatry 1990;157:65-71.
• Modai I, Rinsky H, Cygielman G. The DST as a predictor of acute response to treatment with ECT, chlorimipramine, amitriptyline, and phenelzine. J Clin Psychiatry 1986;47:139-40.
• Mayur P. Ictal electroencephalographic characteristics during electroconvulsive therapy: a review of determination and clinical relevance. J ECT 2006;22:213-7.
• Zisselman MH, Jaffe RL. ECT in the treatment of a patient with catatonia: consent and complications. Am J Psychiatry 2010;167:127-32.
• Kujala I, Rosenvinge B, Bekkelund SI. Clinical outcome and adverse effects of electroconvulsive therapy in elderly psychiatric patients. J Geriatr Psychiatry Neurol 2002;15:73-6.
• Sackeim HA, Luber B, Moeller JR, Prudic J, Devanand DP, Nobler MS. Electrophysiological correlates of the adverse cognitive effects of electroconvulsive therapy. J ECT 2000;16:110-20.
• Nobler MS, Sackeim HA, Slomou M, et al. EEG manifestations during ECT: effects of electrode placement and stimulus intensity. Biol Psychiatry 1993;34:321-30.
• KrystalAD, WeinerRD, Coffey CE, et al. EEG evidence of more Bintense seizure activity with bilateral ECT. Biol Psychiatry 1992;31:617-21.
• Gangadhar BN, Janakiramaiah N, NarayanaDutt D, et al. Strength symmetry index: a measure of seizure adequacy in ECT. Convuls Ther 1997;13:18-24.
• Nobler MS, Luber B, Moeller JR, et al. Quantitative EEG during seizures induced by electroconvulsive therapy: relations to treatment modality and clinical features. I. Global analyses. J ECT 2000;16:211-28.
• Luber B, Nobler MS, Moeller JR, et al. Quantitative EEG during seizures induced by electroconvulsive therapy: relations to treatment modality and clinical features. II. Topographical analyses. J ECT 2000;16:229-43.
• Motreja S, Janakiramaiah N, Gangadhar BN, et al. EEG seizure in bilateral ECT is different between low and high stimulus doses. Clin Electroencephalogr 1998;4:197-9.
• Gangadhar BN, Subbakrishna DK, Janakiramaiah N, et al. Post-seizure EEG fractal dimension of first ECT predicts antidepressant response at two weeks. J Affect Disord 1999;52:235-8.
• Krystal AD, Zaidman C, Greenside HS, et al. The largest Lyapunov exponent of the EEG during ECT seizures as a measure of ECT seizure adequacy. Electroencephalogr Clin Neurophysiol 1997;103:599-606.