Sure, ranomized controlled trials are better than naturalistic trials, but what we need is better memory tests, study other types of memory (everyday memory and semantic memory), longer follow-up and basic research to the question why some of the patients treated with ECT get memory deficits.
In his letter to the editor Prof Sackeim defends his findings of a naturalistic 7 centre trial to the side effects of ECT. He also used a biographical memory test. These tests are at the least not the best tests to examen retrograde amnesia. We should develop more specific and sensitive test for retrograde amnesia. Last month I made a post about better memory tests especially for retrograde anmesia. W're doing a trial with a new test with ECT for retrograde amnesia. Patients are still incuded in this trial.
Moreover as stated in his letter the impact on every day living of retrograde amnesia is still to be researched. Besides everyday memory, semantic memory is of interest.
Also most research on side effects of ECT have a short follow-up. Randomized controlled trials control for such things as late onset depression and the side effects but with longer follow-up w're able to look at the patients in which the depression is the first symptom of cognitive decline.
We now know a lot about dosage, electrode placement and cognitive side effects of ECT, but what we don't know yet is how do these side effects appear, where do they originate. How can we adapt our techniques and devices to lessen cognitive side effects. More important, which individual factors of the patient makes him more or less prone to these cognitive side effects.
Saturday, June 16, 2007
Sackeims letter to the editor about memory loss due to electroshock
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2 comments:
What do you make of this study?
Sackeim Reverses his position on ECT
Now that is useful research. The most important conclusions being:
1. little justification for the first-line use of bilateral ECT
2. no justification for the continued use of sinewave stimulation
3. the individual difference factors related to cognitive outcome should be the most important topic for further research
4. this kind of excellent research should be continued in the form of randomised controlled trials: long term follow-up, RUL electrode placement with different dosages.
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