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Aspirin modulates the anticonvulsant effect of diazepam and sodium valproate in pentylenetetrazole and maximal electroshock induced seizures in mice.

Release of prostaglandins in brain after spontaneous and experimentally induced seizures, has been demonstrated. The possible role of prostaglandins in modulation of seizure activity is still inconclusive. In the present study, the effects of aspirin and its interaction with the anticonvulsants (diazepam and sodium valproate) were studied in pentylenetetrazole (PTZ) and maximal electroshock (MES) induced seizures in mice. Aspirin 50, 100, and 500 mg/kg, i.p. was administered 45 min before the pentylenetetrazole (60 mg/kg, i.p.) and MES (60 mA, 0.2 s duration via car clip electrodes) challenge. In MES seizures significant protection was seen with aspirin 100 mg/kg where as higher dose of aspirin 500 mg/kg was required to elicit maximum protection against PTZ seizures. Sub anticonvulsant dose of sodium valproate 150 mg/kg, i.p. and aspirin 50 mg/kg i.p. showed complete protection in MES seizures and the same dose of sodium valproate offered superior protection in PTZ seizures than either drug used alone. When mice were pretreated with combination of diazepam 0.5 mg/kg and aspirin 50 mg/kg protection was significantly enhanced in PTZ seizures. However, aspirin did not show any significant protection with subanticonvulsant dose of diazepam against MES seizures. The present study suggests that prostaglandins may have anticonvulsant potential and also may have modulatory effect on anticonvulsant effect of conventional antiepileptic drugs.

Animals↗

An Eyewitness Account of the Discovery of Electroshock.

The author was one of the pupils of U. Cerletti and his assistant for almost 20 years. He worked with his master in the discovery of electroshock and in its first application in man in 1938. The author has thought it useful to publish his own testimony for the purpose of making the truth about the events known-the same truth that has often been questioned.

Journal Article↗

[Klemens Maleszewski--the pioneer of electroshock therapy in Polish psychiatry].

On the grounds of Lithuanian and Russian archival materials unpublished so far, the paper presents the professional activity and psychiatric views of Klemens Maleszewski (1798-1873), who was the head of Vilnius's Asylum in 1837-1864. The time of 50s and 60s of the 19th century was a period of increasing attention about metallotherapy and electrotherapy. Above all, these methods were used in the treatment of cholera. Maleszewski conducted researches on the use of galvanic current and metallotherapy not only in cholera treatment, but also in the treatment of psychiatric disorders. He implemented successful electroshock therapy in a 35-year-old catatonic patient in 1861.

Cholera↗

[General anesthesia for electroshock therapy].

Those are a few reflexions to be pondered by psychiatrists, to remind them what are the dangers connected with anesthesia for electroshock-therapy. Some of those risks are well-known: inhalation of gastric liquids, recess in ventilation. Others are somehow more obscure: hyperkalemia, extended curarization after injection of succinylcholine. The risk is therefore still present: to know it is to be ready to face it.

Anesthesia, General↗

Complexing of tissue plasminogen activator with PAI-1, alpha 2-macroglobulin, and C1-inhibitor: studies in patients with defibrination and a fibrinolytic state after electroshock or complicated labor.

Release of tissue plasminogen activator (t-PA) and its interaction with plasma protease inhibitors were studied in two patients with massive defibrination, one after electroshock and soft tissue injury and the other after complicated labor; both had very severe hemorrhage. Large quantities of free t-PA were present in the circulation for several hours. Complexes of t-PA with plasminogen activator inhibitor 1 (PAI-1), alpha 2-macroglobulin and C1-inhibitor were also observed. PAI-1 antigen rose dramatically in both patients, and complexes of t-PA with PAI-1 rose rapidly during the period of observation. In contrast, the complexes of t-PA with alpha 2-macroglobulin and C1-inhibitor, present initially, persisted for short periods only and disappeared when free t-PA disappeared from the circulation. Plasmin was generated initially, as indicated by the presence of plasmin-alpha 2-antiplasmin complexes. Plasma concentrations of alpha 2-macroglobulin, C1-inhibitor, antithrombin III, and alpha 2-antiplasmin were severely depleted initially, but rapidly returned to normal. The observations demonstrate that there is a major release of t-PA in such defibrinating patients, that there is a role for protease inhibitors other than PAI-1 in the regulation of endogenous t-PA, and indicate the great rapidity with which such free t-PA is complexed and cleared.

Adult↗

[Electroshock (cardioversion) treatment problems in rhythm disorders].

Some problems associated with the results from the electroshock treatment of 1027 patients with rhythm disorders are discussed, as well as the choice of the necessary quantity of electric energy and the way of preparation of the patients. It was established, that sinus rhythm restoration was attained in 90.1% under planned conditions, and in emergency cases--in 86.9%. The highest percentage of positive results were obtained with atrial fibrillation (95.6), and the lowest--with paroxysmal supraventricular tachycardia (97.7). The results is identical (88%) with ventricular tachycardia and atrial flutter. The duration of the rhythm disorder is of importance for the result, being the best up to the third month after the origination of the disorder, but good results had been obtained with a longer duration. The quantity of energy from 200 to 300 W/s (median 250 W/s) was outlined as optimal. The mean quantity of electric energy used in atrial flutter was 278.8 +/- 51.7, in paroxysmal supraventricular tachycardia--246.3 +/- 57.8 in atrial fibrillation--229.5 +/- 40.7 and in ventricular tachycardia--182.9 +/- 37.5 W/s. The anticoagulant prophylaxis is carried out in the patients with a longer duration of the rhythm disorder, in the patients with heart defects and those with ischemic heart disease (with eventual aneurysm). There was a single pre-treatment with quinidine--0.20 or 0.40.

Aging↗

Liability and electroshock therapy.

The malpractice status of the use of electroshock therapy (electroencephalotherapy) has been reviewed. In about 40 years, there have been relatively few reported cases dealing with EST (EET) and professional liability. Few cases have been won, and those generally for modest amount. However, future successful claims are expected to reflect current inflation. Certainly the limited volume of litigation would seem to raise a question as to the justification for the extent of the surcharges charged for psychiatric malpractice insurance for the administration of EST. Potential liability for EST continues to be a significant threat to the psychiatric practitioner, although drug matters, suicide, and conformance with legal standards seem a more significant area for current litigation. Those who use EST (EET) can minimize liability exposure by (1) obtaining an informed consent from the patient, (2) describing the method of treatment and possible complications to the family or patient and so noting, (3) ensuring legal authority to treat the patient who is incompetent to give consent or for whom special procedures are required, (4) treating in accordance with accepted procedures, (5) avoiding outpatient EST, if possible, (6) paying close attention to patient complaints, (7) keeping good records, and (8) not promising perfection.

Electroconvulsive Therapy↗