A double-blind randomised clinical trial involving 2,014 patients at 2 elite hospitals in Finland and Finland.
Electroconvulsive therapy, namely deliberate electro-convulsive destruction of neural connections, has been used for decades to treat epilepsy and bipolar disorder. However, it was only recently that neurosurgeons had become aware of the risk of ‘triggered seizures’ in this patient population in the treatment of epilepsy and bipolar disorder.
At least 3 to 6 million patients aged 60 or older use electroconvulsive treatment in Finland.
In Finland, one in eight people undergoing electroconvulsive therapy has a revelation of epilepsy and several of them will subsequently develop bipolar disorder. This is particularly the case with patients who suffer from prolonged tremor. For patients with epilepsy and bipolar disorder, epilepsy is the most common cause of disability. The behavior of bipolar disorder, which increases, especially in later life, is unknown.
To explore the possibility of using electroconvulsive therapy for bipolar disorders, a large randomised trial involving 2,014 patients was conducted in Eli Lilly and company’s patient database in Finland with 2 centres.
Patients were randomly assigned either to standard of care or to the study group. Although it was the standard of care, 51 patients in the electroconvulsive therapy cohort (n = 1,072) never had a telephone discussion with a clinician; 86 patients (n = 202) strongly objected to the therapy.
In the first 14 days of treatment, 3-4 patients in the electroconvulsive therapy group (n = 1,852) underwent these procedures:
In the second 14 days, 3-4 patients in the electroconvulsive therapy group underwent these procedures:
The outcome of the electroconvulsive therapy group’s [n = 2,008] n = 1,062 deaths, while the electroconvulsive therapy cohort’s [n = 2,527] n = 1,059 deaths.
Electroconvulsive therapies were well tolerated, the number of side-effects were small, and the study was short-term.
Commenting on the systematic review and its findings, principal investigator Dr. Annika Sallsinen from the University of Jyväskylä, Finland says:
Individual responses to electroconvulsive therapy ranged from fatigue, sensitivity to nausea and vomiting, and changes of sleep, depression and irritability, and even mild heart rhythm disturbances. Electroconvulsive therapy was associated with rapid worsening of epilepsy. These outcomes may be contradicting to their effects or wildly inaccurate. And these treatments were contraindicated under certain conditions.”