We report a case of an uneventful course after electroconvulsive therapy (ECT) of a patient who had undergone coil embolization for an intracranial aneurysm 37 days earlier. There have been no reports until now of ECT after coil embolization. According to histopathologic examinations, it takes approximately 2 weeks after coil embolization for the aneurysm to become fixed. The ECT can be a therapeutic option even in patients with a previous history of coil embolization, as long as it is performed under proper anesthetic management.
The influence of mexiletine hydrochloride on herpes-related pain responses was examined using mice infected with herpes virus. BALB/c mice were inoculated with herpes simplex virus (HSV; 1 x 10(6) plaque-forming units) on the right hind paw, and the contralateral hind paw was without inoculation. The changes in nociceptive threshold were examined using electric von fray meter. BALB/c mice inoculated with HSV showed a decrease in nociceptive threshold. Intraperitoneal administration of mexiletine prevented the decrease in nociceptive threshold dose-dependently in HSV-inoculated mice, which was firstly observed at a dose of 15.0 mg kg(-1), and peaked at doses more than 17.5 mg kg(-1). This antinociceptive effect of mexiletine attained peaks at 60-90 min after administration and declined gradually to non-treated levels by 150 min. Intraperitoneal administration of mexiletine at a dose of 17.5 mg kg(-1) (but not 10.0 mg kg(-1)) caused significant increase in beta-endorphin levels in the mid brain and hypothalamus of HSV-inoculated mice. However, mexiletine scarcely affected noradrenaline (norepinephrine) levels in the pons and medulla oblongata, even when HSV-inoculated mice were treated with 17.5 mg kg(-1) mexiletine. These results strongly suggested that mexiletine exerts antinociceptive effects on herpes-related pain through enhancement of beta-endorphin levels in the central nervous system in HSV-inoculated mice. It is also suggested that mexiletine will be a good candidate for an antinociceptive drug in the treatment of acute herpetic pain in man.
Abstract Background Few cases of asystole or severe bradycardia occurring after the termination of seizure in the third phase with the dominance of parasympathetic nervous system activity during electroconvulsive therapy (ECT) have been reported. We describe a case of severe bradycardia occurring at the termination of seizure. Case presentation The patient had been diagnosed with bipolar disorder more than 9 years earlier. No adverse hemodynamic events had been observed in over 100 sessions of ECT performed during a 9-year period. ECT was usually induced by propofol and suxamethonium. On this ECT, the heart rate gradually decreased before seizure termination, and severe bradycardia (5–6 beats/min) was identified lasting 15–20 s. Atropine administration immediately before electrical stimulus prevented any further bradycardia during the next session of ECT. Conclusions This case report indicates that attention should be paid to adverse cardiac events related to autonomic nerve activity even before such events occur during ECT.
Electroconvulsive therapy (ECT) recovers the brain function through generalized convulsion induced by electrical stimulation of the brain. While the primary targets of ECT are psychiatric disorders such as depression, schizophrenia, and schizoaffective disorder, it has been well documented that ECT has therapeutic effects on muscular rigidity of Parkinson's disease and neuroleptics-induced malignant syndrome. Recently we demonstrated that ECT reduces intractable pain and allodynia associated with deafferentation pain disorders by recovering the function of the thalamic nucleus. ECT, if applied on appropriate clinical assessments, may contribute to the therapeutics of neuropsychiatric disorders.
Operating Room, Gunma University Hospital, Maebashi, Japan [email protected] Department of Anesthesiology Gunma University School of Medicine Maebashi, Japan. Department of Psychiatry, Minkodo Aburayama Hospital, Fukuoka, Japan. Consent for publication: Written informed consent was obtained from the patient for publication of the two cases reports. The authors have no conflicts of interest or financial disclosures to report. This study was supported in part by a grant to Y.K. (19K09345) from the Japanese Ministry of Education, Culture, Sports, Science and Technology. Y.K. prepared the manuscript and was involved in treating this patient. J.O. and S.S. are anesthesiologists involved in treating this patient. T.S. provided advice on this article. All authors read and approved the final version of the article.
