Gül ERYILMAZ, Işıl GÜL GÖĞCEGÖZ, FERİDE GÖKBEN HIZLI SAYAR, CEMAL ONUR NOYAN, EYLEM ÖZTEN

Kesmek veya kesmemek: Valproatın elektrokonvülzif tedavi ile birlikte kullanımı

Amaç: Valproat ve elektrokonvülzif tedavinin (EKT) bir arada kullanımı tartışmalı bir konudur. Duygudurum düzenleyici olarak kullanılan antikonvülzanların EKT sırasında nöbetin ortaya çıkışını olumsuz etkilemesinden endişe edilir. Bu araştırmada bipolar bozukluk manik nöbet hastalarında EKT ile eş zamanlı kullanılan tam doz veya azaltılmış dozdaki valproatın klinik etkileri incelenmiştir. Yöntem: Nisan 2010-Temmuz 2013 ayları arasında bir psikiyari hastanesinde bipolar bozukluk manik nöbet tanısı ile EKT uygulanan, epileptik olmayan, araştırma ölçütlerine uygun ardışık 75 hastanın kayıtları incelenmiştir. Nöbet için gerekli enerji düzeyi, nöbet süresi, uygulanan elektrokonvülzif tedavi seans sayısı, Young Mani Ölçeği puanlarındaki değişim EKT sırasında tam dozda valproat kullanan, %40 azaltılmış dozda valproat kullanan ve valproat veya başka bir antikonvülzan kullanmayan hasta grupları arasında karşılaştırılmıştır. Bulgular: Üç grup karşılaştırıldığında geçirilen nöbet süreleri açısından kontrol grubu ile valproat doz ayarlaması yapılan grup arasında nöbet süreleri açısından fark saptanmamışken, kontrol grubu ile valproat doz ayarlaması yapılmayan grup arasında nöbet süreleri açısından fark saptanmıştır. Remisyona ulaşmak için gerek duyulan EKT seans sayısı tam doz valproat kullanan grupta anlamlı biçimde daha yüksek bulunmuştur. Valproat ile EKT'nin eş zamanlı kullanımı iyi tolere edilmiş, tam doz veya azaltılmış doz valproat kullanan hastalarda ciddi bir yan etki gözlenmemiştir. Tüm olgularda Young Mani Ölçeği puanında anlamlı düşme ve klinik remisyon gözlenmiştir. Tartışma: Valproatın EKT ile eş zamanlı kullanımı rutin EKT uygulamasına engel oluşturmamış ve koruyucu duygudurum düzenleyici tedavisine geçişi hızlandırmıştır. Bu bulguların doğrulanması ve bilişsel yan etkilerin gruplar arasında karşılaştırılabilmesi için ileriye dönük araştırmalara gerek vardır.

To stop or not to stop? Combined use of valproate and electroconvulsive treatment

Objective: Clinical decision regarding the combination of valproate and electroconvulsive treatment (ECT) has been contradictory. Concerns exist that anticonvulsants that are used a mood stabilizers may interfere with seizure during ECT. This report examines the clinical use of concurrent ECT and valproate in full dose and reduced dose for manic episode of bipolar disorder. Methods: We studied the records of 75 consecutive non-epileptic bipolar disorder manic episode patients referred for ECT between the months of April 2010 and July 2013 in an psychiatric hospital. We compared mean stimulus intensity, mean seizure duration, number of ECTs administered and changes in Young Mania Scale scores between those who were on full dose valproate, 40% reduced dose valproate and those who were not on valproate or other mood stabilizers. Results:Valproate free group and 40% reduced valproate dose group did not significantly differ in seizure duration but full dose valproate group had significantly shorter seizure duration than valproate free group. The full dose valproate group had significantly higher number of ECT sessions required. The treatment combination was well tolerated, with no serious adverse events observed in full dose or reduced dose valproate groups. All 75 patients had significantly reduced scores on Young Mania Scale. Discussion: Concurrent use of valproate with ECT in bipolar diorder manic episode seems safe, did not interfere with routine ECT practice, and allowed for transition to maintenance pharmacotherapy. Prospective studies are required to confirm these findings and also to compare cognitive adverse effects.

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