Cognitive Recovery After Electroconvulsive Therapy and General Anesthesia
Condition: Depression; Delirium; Seizures; Cognitive Disorders
MeSH terms: Delirium; Seizures; Depression; Cognitive Dysfunction; Cognition Disorders
Study type: Interventional

Summary: 
      This study is geared toward characterizing the recovery of brain activity and cognitive
      function following treatments of electroconvulsive therapy and ketamine general anesthesia.
    

Detailed description: 
      Seizures are often associated with loss of consciousness, possibly through effects on
      sub-cortical arousal systems, disruption of cortical-subcortical interactions, and ultimately
      through depressed neocortical function. Furthermore, people are often confused in the
      post-ictal state even when consciousness returns after a seizure. Disrupted cognitive
      function during the postictal phase has not been fully characterized but presents short and
      long-term implications. Many experience an acute disorder of attention, consciousness, and
      cognition, referred to as delirium. Memory deficits are also common. The neurobiology for
      these phenomena are incomplete and challenging to test, as seizures are typically sporadic
      and vary in intensity and character. In contrast, the setting of electroconvulsive therapy
      (ECT) provides the opportunity to study the reconstitution of consciousness and cognition
      following seizures in an elective and predictable context.

      There is no standard agent used to induce general anesthesia during ECT. Ketamine is
      receiving greater attention as an infusion for treating depression and for its potential
      benefits on improving ECT efficacy and expediting cognitive recovery. Further data are needed
      to determine whether ketamine may improve recovery of cognitive function relative to
      etomidate, a commonly used anesthetic for general anesthesia during ECT.

      The investigators will evaluate the cognition function and electroencephalographic patterns
      that accompany the recovery from ECT and general anesthesia. Twenty patients with refractory
      depression will be randomized in this interventional single-blinded randomized crossover
      trial. Each patient will complete seven study visits. The first visit will be conducted
      during the dose-charge titration ECT treatment with etomidate anesthesia. After this session,
      patients will be randomized to three sessions each week for two weeks (six treatments total).
      Over the first week patients will be randomized in order for three treatment arms: (1)
      etomidate general anesthesia and ECT, (2) ketamine general anesthesia and ECT, and (3)
      ketamine alone. Patients will be blinded to the treatment arm for each session. Baseline and
      post-treatment measurements of cognition and ECT will be acquired on each of the six
      treatment sessions.

      Patients that agree will have a MRI.
    

Intervention name(s): Ketamine; Electroconvulsive Therapy
Intervention type(s): Drug; Procedure
Intervention description(s): Ketamine will be used to induce general anesthesia with or without subsequent ECT. Within a single patient, the dose will remain consistent throughout the study and is estimated to be 2 mg/kg.; Dose of the ECT charge will be determined during titration session prior to randomization.
Other intervention name(s): ECT
Intervention MeSH terms: Ketamine
Allocation: Randomized
Intervention model: Crossover Assignment
Masking: Single (Participant)
Primary purpose: Basic Science
Keywords: Anesthesia; Electroconvulsive therapy; Delirium; Electroencephalography; Seizures; Depression; Ketamine; Etomidate; Physiological Effects of Drugs; Pharmacologic Actions; Confusion; Mental Disorders; Neurobehavioral Manifestations; Signs and Symptoms; Neurologic Manifestations; Cognitive Disorders