Pacella, Barrera and Kalinowsky (see animation): Variations in EEG associated with electric shock therapy of patients with mental disorders. Archives of Neurology and psychiatry Vol 47:367-84
One of the earliest reports of the now well established and consistent effect of ECT on the EEG - diffuse slowing. The persistence of slowing is related to number of ECT's with 30% slowing at 6 months in those receiving 18 shocks or more.
Liberson WT and Cadilhac JG: Electroshock and rhinencephalic seizure states. Confinia Neurologica V 13, 276-286
This paper was done in association with the neurosurgeon Scoville who gets the credit for discovering that bitemporal lobectomy has a catastrophic effect on recent memory. This reports experiments with guinea pigs:
"To investigate the epileptogenic sensitivity of different areas of the frontal and temporal lobes. Stimulation of the uncus showed us that this rhinencephalic structure has a particularly developed aptitude to after-discharge."
This phenomenon is now called LTP (Long Term Potentiation) and is the best lead to date for the neural basis of memory registration. This very capacity for after-discharge makes it the most susceptible to seizure activity as this study went on to document:
"The hippocampus (mesial aspect of the temporal lobes) proved to be the most sensitive formation requiring by far the lowest current and being the site of most complex after-discharges."
"When a transcranial electroshock producing stimulation is applied the hippocampus proves to be the most intense participant of the discharging structures."
"Whatever the part of hippocampus may be in the total picture of electroshock, it must be involved to the highest degree(my emphasis) because of its low epileptogenic threshold."
Women's Department, Oslo: Five Cases of Epilepsy Acta Psychiatrica Scandinavica.
The authors declare that causation by ECT impossible to determine due to concomitant lobotomies in some cases.
The hands are those of Walter Freeman, M.D.
Assael et al: Centrencephalic epilepsy induced by electrical convulsive treatment. EEG and Clin Neurophysiology Vol 23, page 195
Small JG: Photoconvulsive and photomyoclonic response in psychiatric patients. EEG and Clin Neurophysiology Vol 2, pages 78-88
ECT facilitates seizures and jerking caused by strobe lights.
Tress and Herberg:Permanent reduction in seizure threshold resulting from repeated electrical stimulation. Experimental Neurology, Vol 37, pages 347-359
Rat study showing temporary elevation of threshold followed by a long term reduction. The brain's increasing resistance to multiple electric shocks is the basis for psychiatrists' repeated claims that ECT is both epileptogenic and anti-convulsant.
Sramka et al: Observation of kindling phenomenon in treatment of pain by stimulation of thalamus.In Sweet, Obradur et al: Neurosurgical treatment in psychiatry, pain and epilepsy. Baltimore. University Park Press. 1975. Pages 651-654.
Focal thalamic stimulation for pain may progressively intensify electric afterdischarges and motor seizure activity by a process that resembles experimental kindling.
Wada: Spontaneous recurrent seizure state induced by daily electric amygdaloid stimulation in Senegalese baboons. Neurology 26:273-286
One of the classic early studies of KINDLING, a model for epilepsy and an instrument for screening drugs for anticonvulsant properties. Obviously too, one more reason shock treatment isn't good for your brain.
Blackwood et al: A study of the incidence of epilepsy following ECT J. Neurology and Neurosurgery, 43:1098-1102.
6 cases of epilepsy de novo following electroshock. All had bilateral ECT. Concludes that this incidence is no higher than background. A model for misleading with statistics.
Weiner RD et al: Prolonged confusional state and EEG seizure activity following concurrent ECT and Lithium use. American Journal of Psychiatry. 137:1452-1453
Various threshold lowering agents have been employed, intentionally and by accident, to amplify the seizure response. Learned controversies arise over the best way to throw gasoline on the fire: Dr. Max Fink, for example, currently favors caffeine while Harold Sackeim, Ph.D. favors sidestepping international standards and constructing more powerful machines as he does at New York State Psychiatric Institute. He is hard at work on a device for seizure induction by enormous magnets.
Weiner RD et al: The persistence of ECT induced changes in the EEG. Journal Nervous and Mental Diseases Vol 168 pages 224-226
Post-ECT EEG changes rarely persist more than two months and do not differ significantly from post-ictal EEG's. Some changes may persist. It is worth noting that EEG's after major tissue loss brain damage including strokes often revert to normal in less than a year.
Brumback and Staton: The EEG pattern during ECT. Clinical Electroencephalography V13, No.3
On page 152 a nice illustration of the "fit switch," the abrupt cessation of seizure activity 30 seconds to a minute after it begins following ECT.
Devisnky O and Duchowny: Seizures after convulsive therapy: a retrospective case survey. Neurology 33:921-925
81 cases reviewed yielding an incidence of epilepsy after ECT 5 times higher than without. 2/3 patients had more than one seizure.
Only 3 pre-ECT EEG's done. Two showed slowing; all were slower after.
12 had EEG's after developing spontaneous seizures: three were normal, two showed diffuse slowing and 7 had focal slowing and/or paroxysmal activity - "all focal EEG changes were localized to the anterior quadrants or temporal regions."
Treatment features not related to occurrence and "generalized (Grand Mal) convulsions were most common but psychomotor seizures and mixed seizure patterns were also described....classic petit mal attacks were not reported."
"A longer latency to fist seizure was associated with greater likelihood of seizure recurrence, a relationship also observed in post-traumatic epilepsy."
This finding is consistent with what is known about the "ripening" of a seizure focus after other kinds of trauma. The authors estimate a 25% chance of recurrence if the first seizure is within one week of ECT and the incidence rose with time to 77%.
"Seizures may actually be significantly under-reported in the recent literature." (No surprise - most adverse effects of ECT are underreported.)
Peters et al: Status epilepticus as a complication of concurrent ECT and theophylline therapy. Mayo Clinic Proceedings 59:568-570.
Important early caveat regarding the need for a washout period before giving ECT - other drugs which can lower seizure threshold include caffeine, lithium, trazodone and to different degrees, the neuroleptic generally with such atypical agents as Wellbutrin and recent agents as Effexor among the worst.
Sackeim H. et al: Seizure threshold and the antidepressant efficacy of ECT. Annals of the NY Academy of Science 462:389-410
This is one of the papers advocating ECT as a treatment for epilepsy on the basis of increasing seizure thresholds with repetitive convulsions. This is called going on the offensive. Claims have been made by proponents that ECT improves memory, treats Parkinson's disease, helps depression in dying Aids patients and, according to Max Fink, is a good screen for pseudo-dementia: before consigning a person to the diagnosis of Alzheimer's, Dr. Fink states one should "bloody well" try a few shock treatments to see if they come around.
Varma and Lee: Nonconvulsive status epilepticus following ECT. Neurology, January, Volume 42.
This case report of a 65 year old woman who, several hours after an uneventful recovery from ECT "developed paroxysmal changes in behavior....became quiet, unresponsive....for about five days...then seen to be alert, oriented...then two hours later was found unresponsive with generalized 2.5 - 3 cps delta (very slow) activity mixed with spike and waves."
The authors call for EEG studies "in prolonged post-ECT confusional states."
"Twilight Status Epilepticus"
Constantino, J. et al: Spontaneous seizure activity as a complication of unilateral ECT: A case report and brief review of the literature.Journal of Nervous and Mental Disease, Williams and Wilkins publishers: Vol 180, No 6.
A 65 year old man who had "successfully" undergone 12 ECT's came in for more. After the sixth caused a seven minute convulsion he was brought for a seventh 3 days later but began convulsing before the ECT could be started. The authors declare their technique to have been impeccably modern and conclude: "To our knowledge this is the first report of a seizure as a complication of modern unilateral ECT."
So much for "new and improved."
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