Risks Of Cognitive Memory Effects; Technique Of Ect - Somatics Thymatron System IV User Manual

Thymatron System IV Instructions for Use
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RISKS OF COGNITIVE MEMORY EFFECTS

Cognitive side effects are experienced in varying types and severity by ECT patients. ECT treatment may be
associated with disorientation, confusion and memory problems, including short-term (anterograde) and long-
term (retrograde or autobiographical) memory loss following treatment. These side effects tend to go away
within a few days to a few months after the last treatment with ECT. However, incomplete recovery is possible.
In rare cases, patients may experience permanent memory loss or other deficiency in cognition or function.
FDA regulations require that each patient receiving ECT have his cognitive status monitored prior to beginning
ECT and throughout the course of treatment via a formal neuropsychological assessment which includes
evaluation of specific cognitive functions (e.g., orientation, attention, memory, executive function).
Neuropsychology consultation should help select tests for individual patients. One tool that may be helpful in
monitoring along the course is the MoCA (Moirand et al, 2018). Maximum MoCA score is 30, normal is 26 or
higher. Add one point if patient is not educated past high school. See Addendum V and:
https://www.parkinsons.va.gov/resources/MOCA-Test-English.pdf. Additional tests may be desirable, such as
for autobiographical memory.
Studies have shown that the methods used in ECT administration have a significant impact on the nature and
magnitude of cognitive deficits. In general, the American Psychiatric Association recognizes that the following
treatment parameters are each independently associated with more pronounced cognitive side effects:
• Bilateral electrode placement;
• Sine wave stimulation;
• High electrical dosage relative to seizure threshold;
• Closely spaced treatments;
• Larger numbers of treatments;
• Concomitant psychotropic medications;
• High dosage of barbiturate anesthetic agents.

TECHNIQUE OF ECT

Users of ECT devices should carefully follow the specific ECT treatment techniques and procedures outlined in
Chapters 6-11 of the American Psychiatric Association's "The Practice of Electroconvulsive Therapy:
Recommendations for Treatment, Training and Privileging – A Task Force Report" (2001).
ECT requires general anesthesia with neuromuscular blocking agents and supported ventilation. These should be
administered by a qualified anesthetic specialist.
Requisite pre-ECT medical and psychiatric assessments in every patient include pertinent medical and
psychiatric history, complete physical examination, ECT anesthesia assessment, dental assessment, and any
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