Chapter 10 - Brain Stimulation Therapies

Question 1

Brain stimulation therapy

Answer 1

Electroconvulsive therapy (ECT) - electrical current induces brief seizure activity while anesthetized
Transcranial magnetic stimulation (TMS) - magnetic pulsations stimulate areas
Vagus nerve stimulation (VNS) - surgical implant in chest provides electrical stimulation through vagus nerve

Question 2

Electroconvulsive Therapy (ECT)

Indications

Answer 2

major depressive disorder
schizophrenia spectrum disorders
schizoaffective disorders
acute manic episodes (4 or more episodes per year)

Question 3

Electroconvulsive Therapy (ECT)

Contraindications

Answer 3

recent MI
hx of CVA
Cerebrovascular malformation
Intracranial mass lesion
Increased intracranial pressure

Question 4

Electroconvulsive Therapy (ECT)

Conditions not effected

Answer 4

substance use disorders
personality disorders
dysthymic disorder

Question 5

Electroconvulsive Therapy (ECT)

Procedure

Answer 5

course = 3x/week, 6-12 tx
meds affecting seizure threshold - d/c a few days before
MAOIs and lithium d/c 2 weeks before
severe hypertension needs to be controlled (ECT will induce)
cardiac conditions monitored
IM inj of atropine sulfate or glycopyrrolate given 30 mins before to decrease secretions and counteract vagal stimulation
fasting, early in AM
bite guard
mechanically ventilated
methohexital IV bolus - anesthetic; then succinylcholine admin for muscle relaxant
cuff on one limb to block relaxant to monitor distal activity
electrical stimulus 0.2-0.8 sec
seizures can last 25-60 sec

Question 6

Electroconvulsive Therapy (ECT)

postpocedure

Answer 6

positioned on side

monitor return of gag reflex

Question 7

Electroconvulsive Therapy (ECT)

Complications

Answer 7

memory loss and confusion
reactions to anesthesia
ECG changes (expected to increase by 25% until recovery)
headache, muscle soreness, nausea
relapse of depression

Question 8

Transcranial magnetic stimulation (TMS)

Indications

Answer 8

major depressive disorder

Question 9

Transcranial magnetic stimulation (TMS)

procedure

Answer 9

qd for 4-6 weeks
outpatient
30-40 mins
alert

Question 10

Transcranial magnetic stimulation (TMS)

complications

Answer 10

mild discomfort/tingling
lightheadedness after
seizures

Question 11

Vagus nerve stimulation (VNS)

Indications

Answer 11

depression

Question 12

Vagus nerve stimulation (VNS)

procedure

Answer 12

outpatient surgical
around-the-clock programmed pulsations
client can turn off by placing magnet over chest

Question 13

Vagus nerve stimulation (VNS)

complications

Answer 13

voice changes
hoarseness, throat/neck pain, dysphagia
dyspnea (client should turn off during exercise)