Biomedical subjects
Rajiv Tandon
Publications and source records attributed to Rajiv Tandon.
Post-ECT Myoclonic Jerks in a Depressed Patient with Bulimia.
We describe an individual with psychotic depression and bulimia who demonstrated spontaneous post-electroconvulsive therapy (ECT) myoclonic jerks after her fifth unilateral treatment. After switching to bilateral ECT, the patient developed generalized tonic-clonic seizures, beginning about 2 min after each treatment and lasting for about 4 min. These were confirmed by electroencephalographic (EEG) recording, and could be terminated and also effectively prevented by intravenous midazolam. Differential diagnosis, risk factors, and management are discussed.
Post-ECT Dyskinesia.
Three depressed individuals who developed a transient dyskinesia after right unilateral, nondominant electroconvulsive therapy (ECT) are described. The patients responded well to ECT in terms of their affective disorders, and were discharged free of permanent ECT-induced movement disorder symptoms. Risk factors and possible neurochemical changes underlying this phenomenon are discussed.
Relative Efficacy of Unilateral and Bilateral Electroconvulsive Therapy in Melancholia.
We compared the efficacy of unilateral nondominant (n = 15) and bilateral (n = 31) electroconvulsive therapy (ECT) in melancholia in 46 consecutive, nonrandomly assigned medication-free patients with endogenous depression. Seizure duration was recorded and, if a seizure lasted <25 s, the stimulus was immediately readministered. There were more missed or brief seizures that required restimulation with unilateral ECT than with bilateral ECT. After five treatments, blind assessments on the Hamilton Rating Scale for Depression showed a 57% improvement in the bilateral group as compared with a 19% improvement in the unilateral group. The unilateral group received more total treatments (mean = 9.9) than did the bilateral group (mean = 7.7). At the conclusion of all ECT treatments, 72% of patients receiving bilateral ECT were substantially improved and 14% partially improved, compared with 32% of patients receiving unilateral ECT with substantial improvement and 30% partial improvement. This difference between the two groups, however, had disappeared by the time of discharge. Although unilateral ECT may induce fewer side effects, we find bilateral treatments to be more efficacious, at least on a short-term basis.
ECT in Post-Stroke Major Depression.
A depressed male patient, who had his first affective disturbance as a complication of a right parietotemporal cerebrovascular accident, was treated with unilateral, nondominant electroconvulsive therapy, administered ipsilateral to the lesion. This procedure produced adequate seizure duration with excellent clinical results and without new neurological or neuropsychological deficits.