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OPTIMISATION DE L'ÉLECTROCONVULSIVOTHÉRAPIE (ECT) PAR L'ADJONCTION DE KÉTAMINE À L'ANESTHÉSIE Aspect théorique et expérience dans la dépression (étude KEOpS)

Abstract : Electroconvulsive therapy (ECT) is recommended in resistant depression. In a first part, we analyze its theoretical aspects (as its mode of action). In the second part, we detail the realization of a pilot study of optimization of the CT. Mechanisms of action of the CT are poorly known. One of the hypotheses of action of the ECT is called neurotrophic and involves changes in neuroplasticity via the glutamate pathway and the NMDA receptors. Ketamine, an anesthetic anti-NMDA, would have a neurotrophic action and protect against excitotoxicity. It would promote the efficiency and cognitive tolerance of the ECT. We performed a controlled and randomized study. Patients received either ketamine (0.5 mg / kg) or placebo, as add-on, propofol before CT. The evaluation was performed using clinical scales of depression and cognitive tolerance. The main objective is the study of efficiency and tolerance. 5 patients were included in the ketamine group and 5 in the placebo group. At inclusion, the intensity of symptoms was the same, but groups differed in the severity and resistance of depression. The efficiency analysis did not show any differences. The quality of the seizures was lower with ketamine. Cognitive tolerance improved with ketamine. No severe side effects were observed. Our study is limited by important biases. The lack of effectiveness is probably related to the inhomogeneity of the groups. On the cognitive level, our results seem to show a neuroprotective effect of ketamine. A larger study should be put in place
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https://tel.archives-ouvertes.fr/tel-02084153
Contributor : Sylvain Iceta <>
Submitted on : Thursday, April 11, 2019 - 2:18:49 PM
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Sylvain Iceta. OPTIMISATION DE L'ÉLECTROCONVULSIVOTHÉRAPIE (ECT) PAR L'ADJONCTION DE KÉTAMINE À L'ANESTHÉSIE Aspect théorique et expérience dans la dépression (étude KEOpS). Médecine humaine et pathologie. Lyon1, 2013. Français. ⟨tel-02084153⟩

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