Everything you need to know about seismotherapy, or electroconvulsive therapy (ECT)

Seismotherapy, also called electroconvulsive therapy (ECT), is in a way 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 the usual treatments. What exactly does it consist of? We take stock.

Definition: what is seismotherapy?

Seismotherapy consists of provoking an epileptic fit under general anesthesia, via a short, weak electric current transmitted through the skull. More concretely, the medical team places two electrodes at the level of the patient’s temples: which allows the alternating current to cross his skull. Said patient is therefore subjected to a painless convulsive crisis, with therapeutic effects. Its main advantages are the speed of action and the lower occurrence of side effects. In addition, it is integrated into the management of many psychic and psychiatric disorders.

If 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 ? The secondary effects linked to electroshock and the 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 1990s, 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 practice, under the aegis of the National Agency for Accreditation and Evaluation in Health (Anaes).

On what principle does it work?

By reflex, when subjected to a seizure, the brain secretes neurotransmitters and neurohormones (dopamine, norepinephrine, serotonin, etc.) involved in various mood disorders. These substances thus stimulate the neurons and promote the creation of new neural connections.

Depression, bipolar disorder, schizophrenia… When to do seismotherapy?

As the Institute for Research and Documentation in Health Economics reminds us in a report published in April 2022, this procedure presentshigh efficiency in the management of mood disorders resistant to conventional treatments (medication and psychotherapy):

  • depression ;
  • catatonic syndrome
  • and 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’s syndrome or even certain obsessive-compulsive disorders (OCD).

Who prescribes seismotherapy? Where to do the sessions?

Electroconvulsive therapy necessarily involves the informed consent of the patient. It is only considered as a last resort, after thorough examination and full evaluation 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 response prior to shock therapy;
  • and suicide risk.

Sessions are administered by a psychiatrist, an anesthesiologist and nurses, but not all establishments practice earthquake therapy. “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 usually includes 12 to 20 sessions (two to three weekly sessions). “In the case of emergency treatments linked to a life-threatening commitment, the cure may stop as soon as the signs of gravity disappear such as catatonic characteristics, a state of agitation or a suicidal crisis”, specifies however the Institute for Research and Documentation in Health Economics. A maintenance or maintenance treatment can also be administered in the prevention of relapse and then includes sessions spaced a month apart which can be performed on an outpatient basis. In summary, the number of sessions varies from patient to patient, depending on the severity of his pathology and reception. The medical condition of the patients is therefore regularly assessed by the medical team.

The electroconvulsive therapy sessions are carried out in the hospital, in an outpatient department or as part of a longer hospital stay. They are provided by a psychiatrist, assisted by an anesthesiologist and nurses. A prior consultation takes place with the anesthetist to rule out any contraindication to general anesthesia.

On D-day, the patient presents with an empty stomach. He is placed under perfusion and monitoring. An electroencephalogram also reports on 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 limits excessive muscle convulsions.

Once this has been set up, it is up to the psychiatrist to administer the electroshocks using electrodes implanted on either side of the brain (at the temples). The 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 seizure. 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 supervised by a third person for almost 24 hours.

Electroconvulsive therapy: what are the side effects and contraindications?

The most common side effects of ECT should be clearly explained to the patient: headaches, confusion, memory impairment and impaired executive functions. Fortunately, they are transient.

More rarely, one can observe mechanical injuries at the level of the teeth, shoulders or vertebrae when the curarization was not sufficient and did not allow the patient to be immobilized.

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 indeed increases the tension inside the skull). Without forgetting the contraindications related to general anesthesia, which are discussed upstream by the medical team.

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