ELECTRO CONVULSIVE

THERAPY & TRANSCRANIAL

MAGNETIC STIMULATION
DHARMAWAN A. PURNAMA
PENDAHULUAN

• Electroconvulsive therapy (ECT) is a procedure, done under general anesthesia, in which small electric
currents are passed through the brain, intentionally triggering a brief seizure. ECT seems to cause
changes in brain chemistry that can quickly reverse symptoms of certain mental illnesses.
• ECT often works when other treatments are unsuccessful and when the full course of treatment is
completed, but it may not work for everyone.
• Much of the stigma attached to ECT is based on early treatments in which high doses of electricity were
administered without anesthesia, leading to memory loss, fractured bones and other serious side effects.
• ECT is much safer today. Although ECT still causes some side effects, it now uses electric currents given
in a controlled setting to achieve the most benefit with the fewest possible risks.
 ELECTROCONVULSIVE THERAPY (ECT) CAN PROVIDE RAPID, SIGNIFICANT
IMPROVEMENTS IN SEVERE SYMPTOMS OF SEVERAL MENTAL HEALTH
CONDITIONS. ECT IS USED TO TREAT:

• Severe depression, particularly when accompanied by detachment from reality (psychosis), a desire to commit suicide or refusal to eat.

• Treatment-resistant depression, a severe depression that doesn't improve with medications or other treatments.

• Severe mania, a state of intense euphoria, agitation or hyperactivity that occurs as part of bipolar disorder. Other signs of mania include impaired decision-making,
impulsive or risky behavior, substance abuse, and psychosis.

• Catatonia, characterized by lack of movement, fast or strange movements, lack of speech, and other symptoms. It's associated with schizophrenia and certain other
psychiatric disorders. In some cases, catatonia is caused by a medical illness.

• Treatment-resistant hallucination

• Agitation and aggression in people with dementia, which can be difficult to treat and negatively affect quality of life.

• ECT may be a good treatment option when medications aren't tolerated or other forms of therapy haven't worked. In some cases ECT is used:

• During pregnancy, when medications can't be taken because they might harm the developing fetus

• In older adults who can't tolerate drug side effects

• In people who prefer ECT treatments over taking medications

• When ECT has been successful in the past

RISIKO DAN EFEK SAMPING ECT:

• Confusion. Immediately after treatment, you may experience confusion, which can last from a few minutes to
several hours. You may not know where you are or why you're there. Rarely, confusion may last several days or
longer. Confusion is generally more noticeable in older adults.
• Memory loss. Some people have trouble remembering events that occurred right before treatment or in the
weeks or months before treatment or, rarely, from previous years. This condition is called retrograde amnesia.
You may also have trouble recalling events that occurred during the weeks of your treatment. For most people,
these memory problems usually improve within a couple of months after treatment ends.
• Physical side effects. On the days of an ECT treatment, some people experience nausea, headache, jaw pain
or muscle ache. These generally can be treated with medications.
• Medical complications. As with any type of medical procedure, especially one that involves anesthesia, there
are risks of medical complications. During ECT, heart rate and blood pressure increase, and in rare cases, that
can lead to serious heart problems. If you have heart problems, ECT may be more risky.
PROSEDUR ECT:

• General anesthesia. Puasa. Hanya boleh sedikit air untuk menelam obat di pagi hari.
• Evaluasi fisik. Secara umum memeriksa jantung dan paru
• Dipasang IV lines.
• Electrode pads on your head. Each pad is about the size of a silver dollar. ECT can be
unilateral, in which electric currents focus on only one side of the brain, or bilateral
(BITEMPORAL), in which both sides of the brain receive focused electric currents.
POSISI ECT YANG UMUM DILAKUKAN
ANESTESI

• Muscle relaxant
Succynil coline (tidak tersedia di Indonesia) jadi pakai propovol (ada sedikit efek musle
relaxan)
• Sedatif biasanya digunakan yang short acting seperti midazolam.
• During the procedure:
• A blood pressure cuff placed around your ankle stops the muscle relaxant medication
from entering the foot and affecting the muscles there. When the procedure begins, your
doctor can monitor seizure activity by watching for movement in that foot.
• Monitors check your brain, heart, blood pressure and oxygen use.
• You may be given oxygen through an oxygen mask.
• You may also be given a mouth guard to help protect your teeth and tongue from injury.
MEMULAI KEJANG

• When you're asleep from the anesthetic and your muscles are relaxed, the doctor presses a button on the ECT
machine. This causes a small amount of electric current to pass through the electrodes to your brain, producing
a seizure that usually lasts less than 60 seconds.
• Because of the anesthetic and muscle relaxant, you remain relaxed and unaware of the seizure. The only
outward indication that you're having a seizure may be a rhythmic movement of your foot if there's a blood
pressure cuff around your ankle.
• Internally, activity in your brain increases dramatically. A test called an electroencephalogram (EEG) records the
electrical activity in your brain. Sudden, increased activity on the EEG signals the beginning of a seizure, followed
by a leveling off that shows the seizure is over.
• A few minutes later, the effects of the short-acting anesthetic and muscle relaxant begin to wear off. You're
taken to a recovery area, where you're monitored for problems. When you wake up, you may experience a
period of confusion lasting from a few minutes to a few hours or more.
• In Indonesia, ECT treatments are generally given three times weekly for three to four
weeks — for a total of six to 12 treatments.
• The number and type of treatments you'll need depends on the severity of your
symptoms and how rapidly they improve.
• Bisa dilakukan outpatient
• Many people begin to notice an improvement in their symptoms after about six treatments with
electroconvulsive therapy. Full improvement may take longer, though ECT may not work for
everyone. Response to antidepressant medications, in comparison, can take several weeks or
more.
• No one knows for certain how ECT helps treat severe depression and other mental illnesses.
What is known, though, is that many chemical aspects of brain function are changed during and
after seizure activity. These chemical changes may build upon one another, somehow reducing
symptoms of severe depression or other mental illnesses.That's why ECT is most effective in
people who receive a full course of multiple treatments.
• Even after your symptoms improve, you'll still need ongoing depression treatment to prevent a
recurrence. Ongoing treatment may be ECT with less frequency, but more often, it includes
antidepressants or other medications, or psychological counseling (psychotherapy).
 TRANSCRANIAL MAGNETIC STIMULATION

• rTMS adalah metode terapi non invasif untuk stimulasi otak dengan
menggunakan magnet yang ditargetkan pada suatu area tertentu di otak.
Pengaplikasian stimulasi berulang dapat memberbaiki komunikasi antar sel melalui
potensiasi jangka panjang. Pada pelaksanaannya tidak dibutuhkan anestesi seperti
pada terapi ECT, sehingga dapat menurunkan efek samping dari obat-obatan dan
memiliki risiko yang jauh lebih rendah.

• Prosedur ini berlangsung selama kurang lebih 15-30 menit per sesinya. Jumlah
sesi terapi menyesuaikan dengan tingkat keparahan dan jenis penyakit yang
diderita (biasanya 5 hari per minggu, durasi hitungan minggu - bulan). Saat
prosedur berlangsung, pasien diposisikan duduk dan kumparan elektromagnetik
akan dipasangkan didekat kepala pasien. Kemudian gelombang magnetic tersebut
akan bergerak menuju bagian otak yang dituju dan menginduksi saraf-saraf
tertentu. Target otak yang dituju berbeda-beda dengan frekeuensi yang bervariasi
sesuai dengan penyakitnya.

• Umumnya terapi ini digunakan untuk mengobati penyakit-penyakit psikiatri

seperti depresi atau skizofrenia, namun ternyata manfaatnya juga ditemukan
untuk penyakit lain, seperti penyakit neurologis. Bahkan baru-baru ini ditemukan
bahwa rTMS dapat membedakan jenis gangguan kognitif.
page 14

RTMS
• Terapi non invasif untuk stimulasi otak dengan
menggunakan magnet yang ditargetkan pada suatu area
tertentu di otak.
• Pengaplikasian stimulasi berulang dapat memberbaiki
komunikasi antar sel melalui potensiasi jangka panjang.
• Pada pelaksanaannya tidak dibutuhkan anestesi
• Prosedur : ± 15-30 menit per sesinya
• Pasien diposisikan duduk dan kumparan elektromagnetik
akan dipasangkan didekat kepala pasien. Kemudian
gelombang magnetic tersebut akan bergerak menuju
bagian otak yang dituju dan menginduksi saraf-saraf
tertentu.
• Efek samping yang mungkin timbul dari prosedur ini antara lain adalah :

• Rasa mengambang

• Gangguan pendengaran sementara

• Nyeri kepala ringan

• Kesemutan di wajah

• Kejang (sangat jarang)

• Kontra indikasi rTMS adalah :

• Klip / kumparan aneurisma

• Pecahan peluru

• Alat pacu jantung atau ICD (implantable cardioverter defibrillators)

• Tato wajah dengan tinta magnetic yang sensitive terhadap magnet

• Stimulator yang diimplantasi

• Implan metal di telinga atau mata

• Stent di leher atau kepala

• https://www.healthline.com/health/depression/repetitive-transcranial-magnetic-stimulation#how-it-works

• https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3271460/?report=printable

•
• Efek samping yang mungkin timbul dari prosedur ini antara lain adalah :

• Rasa mengambang

• Gangguan pendengaran sementara

• Nyeri kepala ringan

• Kesemutan di wajah

• Kejang (sangat jarang)

• Kontra indikasi rTMS adalah :

• Klip / kumparan aneurisma

• Pecahan peluru

• Alat pacu jantung atau ICD (implantable cardioverter defibrillators)

• Tato wajah dengan tinta magnetic yang sensitive terhadap magnet

• Stimulator yang diimplantasi

• Implan metal di telinga atau mata

• Stent di leher atau kepala

• https://www.healthline.com/health/depression/repetitive-transcranial-magnetic-stimulation#how-it-works

• https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3271460/?report=printable
•