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Journal of ECT:
doi: 10.1097/YCT.0000000000000110
Invited Reviews

The Seizure, Not Electricity, Is Essential in Convulsive Therapy: The Flurothyl Experience

Fink, Max MD

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Abstract

Background

For more than 50 years, research in convulsive therapy has been focused on the impact of electricity and seizures on memory and not on brain chemistry or neurophysiology. Brief pulse and ultrabrief pulse currents replaced sinusoidal currents. Electrode placements were varied, energy dosing was altered, and electricity was replaced by magnetic currents.

Method

The published experiences and archival records of seizures induced by camphor, pentylenetetrazol, and flurothyl are reviewed and compared with the changes induced by electricity.

Findings

The clinical efficacy of chemically induced seizures is equal to that of electrical inductions. Seizure durations are longer, and impairment of cognition and memory is less. Electroconvulsive therapy replaced chemical treatments for ease of use, not for greater efficacy or safety.

Conclusions

The brain seizure, not the method of induction, is the essential element in the efficacy of convulsive therapy. Seizure induction with chemicals avoids the direct effects of electricity on brain functions with lesser effects on cognition.

Reexamination of chemical inductions of seizures as replacements for electricity is encouraged.

Copyright © 2014 by Lippincott Williams & Wilkins

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