- 學位論文
重鬱症病人接受電痙攣治療療效預測指標評估
Predictors for the efficacy of ECT in major depressive patients:clinical and quantitative electroencephalogram study
摘要
背景：重鬱症(major depressive disorder, MDD)是一種可能引起失能的精神疾病，約有50%的病人病情呈現慢性化，20%的病人對藥物治療無法有足夠的臨床反應。自從1938年電痙攣治療(electroconvulsive therapy, ECT)開始應用於臨床之後，ECT一直是治療重鬱症最快速，有效的方法，到目前對ECT改善疾病的機轉仍然不清楚，本研究以預測指標為依據，探討ECT的療效，期待能找到早期預測ECT的療效指標，提供臨床醫師在執行ECT過程中達到更有效及更精準的治療。 方法：本研究包含難治型憂鬱症病人20位接受ECT治療，其中18位完成7次以上前後測試。臨床資料收集包括臨床變項(年齡、性別、婚姻、教育程度、發病年齡、發病年限)及腦波變項(目測痙攣時間、腦波痙攣時間、棘波、棘徐波、頻率、發作後的腦波抑制、使用電壓)並分析這些變項對漢米爾頓憂鬱量表-17(HAD-D-17,簡稱HAM)的影響及其相關性。 結果：在探討預測值有效、無效較有意義的電學及臨床指標，包括痙攣腦波時間，痙攣腦波中的棘徐波，發作後的腦波抑制及漢米頓憂鬱量表指數在兩組中達有意義的差別。在預測模式利用複回歸分析發現經過調整後，在其它變項維持不變的情形下第二週的HAM改善率每增加1%則第三週的改善率增加0.807，在經過週整後其它變項維持不變的情形下，HAM改變50%為有效組相對於無效組，第三週的痙攣後腦波抑制程度(postictal suppression)明顯為177.968倍。 結論：ECT臨床的療效在研究中，腦波的痙攣時間比目測時間對預測有較佳的效果。其它如棘徐波及痙攣停止後的腦波抑制，尤其痙攣停止後腦波的抑制對臨床的療效預測更佳。臨床上我們常用HAM 評分來做為臨床療效指標，本文經利用兩獨立樣本比較，相關係數比較，複迴歸分析，對數迴歸分析結果HAM與痙攣後腦波抑制程度亦有很高的相關性，因此在電痙攣執行中，臨床醫師可直接目測腦電位的變化及痙攣後電位抑制程度來導引一個更有效的痙攣發作，使ECT的執行對臨床的療效能更有效及快速的掌握。
並列摘要
Background：Electroconvulsive therapy(ECT) is an established effective treatment modality for patients with severe depression. Several variables have been suggested that can predict the efficacy of ECT in patients suffering from depression. The aim of this study is to create an index of EEG and clinical findings for the prediction the response of ECT. Methods：20 depressive patients referred for ECT were included. Poor response was defined as a decrease in Hamilton Rating Depression Scale less than 50%. Informations were gathered for predictors including sex, age, duration of index episode, seizure duration clinically and electrophysiologically, EEG variables & postictal suppression. ECT was given third times per week from April 2007 to Oct. 2008; The 17-item Hamilton Rating Scale for depression (HAM-D-17) was applied at baseline and weekly during the course. Results：In this prospective study, decrease at least 50% in Hamilton Depression Scale (17 items) was considered as effective outcome. Twelve patients (60.0%) remitted. Comparison between responders & nonresponders, it shows significant differences with respect to HAM2, HAM3, Seizure duration at week 2, spike & wave phase duration at week 2, postictal suppression at week1, week2, week3. Forward stepwise logistic regcssion analysis selected only degree of postictal suppression at week 3 as a significant predictor for ECT efficacy. Conclusion：Degree of postictal suppression was the best significant variable found to predict the efficacy of ECT