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Biomedical subjects

Harold A. Sackeim

Publications and source records attributed to Harold A. Sackeim.

At least 19 recordsLinked to original sources
PubMed2000

Transcranial magnetic stimulation: applications in basic neuroscience and neuropsychopharmacology.

Introduced 15 years ago, transcranial magnetic stimulation (TMS) is a non-invasive means of stimulating the cortex that has proved to be a unique tool for probing brain-behaviour relationships. While a therapeutic role for TMS in neuropsychiatry is uncertain, the utility of TMS in studying brain function has been demonstrated in diverse neuroscience applications. We review studies in animals on the mechanisms of action of TMS, and present a summary of the applications of TMS in basic neuroscience. TMS is still a relatively young technique, and unanswered questions remain regarding its acute and chronic impact on neural excitability and various aspects of brain function. Nonetheless, recent work with TMS has demonstrated its unique role in complementing other tools for studying brain function. As a brain intervention tool, TMS holds the promise of moving beyond correlative studies to help define the functional role of cortical regions in selected cognitive and affective processes.

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PubMed1993

Augmentation Strategies in Electroconvulsive Therapy: A Synthesis.

Over the past four decades, a variety of pharmacological augmentation strategies have been used in electroconvulsive therapy (ECT). Their goal has been to enhance therapeutic effects and seizure manifestations, or to minimize cognitive effects. Although they are not intended to affect outcome or other clinical parameters, medications taken during ECT may also impact on safety and efficacy. There is a large literature in epileptology on how pharmacologic agents affect seizure physiology. We review the clinical literature on augmentation strategies in ECT, with a synopsis of relevant preclinical studies, and seek to relate the pharmacological effects on seizure parameters to critical clinical variables in ECT.

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PubMed1991

Optimizing Unilateral Electroconvulsive Therapy.

Review of the unilateral-bilateral literature cannot identify the factors that optimize the efficacy of right unilateral electroconvulsive therapy (ECT) (RUL), and we should not confuse hunches with facts. With the exception of stimulus dosing, there is little experimental support that the conditions suggested by Dr. J.-O. Ottosson affect RUL efficacy. The theoretical position that eliciting a full, maximally generalized seizure provides the basis for optimal efficacy also lacks experimental support and is imprecise. Further, the conditions proposed to optimize RUL efficacy also augment its side effect profile. We do not know whether an optimal form of RUL will retain cognitive advantages if compared to optimal bilateral ECT. We also lack a clinically useful marker that an optimal form of RUL has been delivered. Under these conditions, it seems appropriate that the choice of electrode placement be made on an informed case-by-case basis.

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PubMed1989

Clinical Features and Predictors of Postictal Excitement.

In a retrospective case control study, clinical features of postictal excitement following electroconvulsive therapy (ECT) were examined in 24 patients and 24 matched controls. The two groups did not differ in clinical outcome, degree of pretreatment agitation, anesthetic or succinylcholine dose, number of ECTs received, mean seizure duration, number of titrated treatments with subconvulsive stimulation, or type of EEG ending. Patients who became excited early in the treatment course rarely manifested this phenomenon at all subsequent treatments. Within the "excited" group, a minority of patients became excited following the first ECT, and only 34.3% of their treatments resulted in postictal excitement. It may not be necessary to routinely use postseizure benzodiazepines in patients who have once exhibited a postictal excitement.

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PubMed1988

Unilateral ECT in the Treatment of Manic Episodes.

It has been suggested that unilateral electroconvulsive therapy (ECT) is less effective than bilateral ECT in manic patients. In a pilot study, six medication-resistant manic patients received either left or right unilateral ECT. In an ongoing study, 14 similar patients were randomly assigned to receive left unilateral, right unilateral, or bilateral ECT. Across both studies, a therapeutic equivalence for unilateral and bilateral ECT was found. Possible reasons for disparate findings with respect to the efficacy of unilateral ECT in mania are discussed.

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PubMed1988

Seizure Elicitation Blocked by Pretreatment with Lidocaine.

A patient is reported in whom pretreatment with intravenous lidocaine resulted in failure to elicit a seizure even at stimulus intensity markedly greater than that used successfully at prior and subsequent treatments. Together with one other report, this experience suggests that lidocaine may prevent a seizure by raising the seizure threshold. An alternative explanation is proposed for the classic findings of Ottosson that lidocaine-modified seizures are reduced in therapeutic efficacy.

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PubMed1987

Reliability and Validity of Measures of Seizure Duration.

Two raters independently assessed seizure duration in single-channel electroencephalogram (EEG) records obtained in 479 electroconvulsive treatments of 52 patients. Ratings of seizure duration were highly reliable. The measures of EEG seizure duration were substantially associated with the duration of motor manifestations, supporting the validity of the EEG determinations. Confidence ratings of the clarity of the endpoint of EEG paroxysmal activity were unrelated to the duration of seizures in EEG and motor measures. The extent to which the EEG seizure activity extended beyond the motor manifestations was strongly related to the total duration of the EEG seizure manifestations and not to the duration of motor manifestations.

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