Abstract
Background
Electroconvulsive therapy (ECT) remains the most effective acute treatment for severe
major depression, but with significant risk of adverse cognitive effects. Unidirectional
electrical stimulation with a novel electrode placement and geometry (Focal Electrically
Administered Seizure Therapy (FEAST)) has been proposed as a means to initiate seizures
in prefrontal cortex prior to secondary generalization. As such, it may have fewer
cognitive side effects than traditional ECT. We report on its first human clinical
application.
Method
Seventeen unmedicated depressed adults (5 men; 3 bipolar disorder; age 53 ± 16 years)
were recruited after being referred for ECT. Open-label FEAST was administered with
a modified spECTrum 5000Q device and a traditional ECT dosing regimen until patients
clinically responded. Clinical and cognitive assessments were obtained at baseline,
and end of course. Time to orientation recovery, a predictor of long-term amnestic
effects, was assessed at each treatment. Nonresponders to FEAST were transitioned
to conventional ECT.
Results
One patient withdrew from the study after a single titration session. After the course
of FEAST (median 10 sessions), there was a 46.1 ± 35.5% improvement in Hamilton Rating
Scale for Depression (HRSD24) scores compared to baseline (33.1 ± 6.8, 16.8 ± 10.9; P < 0.0001). Eight of 16 patients met response criteria (50% decrease in HRSD24) and 5/16 met remission criteria (HRSD24 ≤ 10). Patients achieved full re-orientation (4 of 5 items) in 5.5 ± 6.4 min (median = 3.6),
timed from when their eyes first opened after treatment.
Conclusion
In this feasibility study, FEAST produced clinically meaningful antidepressant improvement,
with relatively short time to reorientation. Our preliminary work first in primates
and now depressed adults demonstrates that FEAST is feasible, safe, well-tolerated
and, if efficacy can be optimized, has potential to replace traditional ECT.
Keywords
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Article info
Publication history
Published online: March 18, 2013
Accepted:
March 7,
2013
Received in revised form:
February 9,
2013
Received:
September 20,
2012
Identification
Copyright
© 2013 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
