Clinical effects of nonconvulsive electrotherapy combined with mindfulness-based stress reduction and changes of serum inflammatory factors in depression

BACKGROUND Depression is a common and serious psychological condition,which seriously affects individual well-being and functional ability.Traditional treatment methods include drug therapy and psychological counseling;however,these methods have different degrees of side effects and limitations.In recent years,nonconvulsive electrotherapy(NET)has attracted increasing attention as a noninvasive treatment method.However,the clinical efficacy and potential mechanism of NET on depression are still unclear.We hypothesized that NET has a positive clinical effect in the treatment of depression,and may have a regulatory effect on serum inflammatory factors during treatment.AIM To assess the effects of NET on depression and analyze changes in serum inflammatory factors.METHODS This retrospective study enrolled 140 patients undergoing treatment for depression between May 2017 and June 2022,the observation group that received a combination of mindfulness-based stress reduction(MBSR)and NET treatment(n=70)and the control group that only received MBSR therapy(n=70).The clinical effectiveness of the treatment was evaluated by assessing various factors,including the Hamilton Depression Scale(HAMD)-17,self-rating idea of suicide scale(SSIOS),Pittsburgh Sleep Quality Index(PSQI),and levels of serum inflammatory factors before and after 8 wk of treatment.The quality of life scores between the two groups were compared.Comparisons were made using t and χ^(2) tests.RESULTS After 8 wk of treatment,the observation group exhibited a 91.43%overall effectiveness rate which was higher than that of the control group which was 74.29%(64 vs 52,χ^(2)=7.241;P<0.05).The HAMD,SSIOS,and PSQI scores showed a significant decrease in both groups.Moreover,the observation group had lower scores than the control group(10.37±2.04 vs 14.02±2.16,t=10.280;1.67±0.28 vs 0.87±0.12,t=21.970;5.29±1.33 vs 7.94±1.35,t=11.700;P both<0.001).Additionally,there was a notable decrease in the IL-2,IL-1β,and IL-6 in both groups after treatment.Furthermore,the observation group exhibited superior serum inflammatory factors compared to the control group(70.12±10.32 vs 102.24±20.21,t=11.840;19.35±2.46 vs 22.27±2.13,t=7.508;32.25±4.6 vs 39.42±4.23,t=9.565;P both<0.001).Moreover,the observation group exhibited significantly improved quality of life scores compared to the control group(Social function:19.25±2.76 vs 16.23±2.34;Emotions:18.54±2.83 vs 12.28±2.16;Environment:18.49±2.48 vs 16.56±3.44;Physical health:19.53±2.39 vs 16.62±3.46;P both<0.001)after treatment.CONCLUSION MBSR combined with NET effectively alleviates depression,lowers inflammation(IL-2,IL-1β,and IL-6),reduces suicidal thoughts,enhances sleep,and improves the quality of life of individuals with depression.

Propofol pump controls nonconvulsive status epilepticus in a hepatic encephalopathy patient: A case report

BACKGROUND Status epilepticus is an emergent and critical condition which needs management without hesitation. Nonconvulsive status epilepticus (NCSE) tends to be less recognized, and its diagnosis is delayed in comparison with overt status epilepticus because of the absence of specific clinical signs. It is often difficult to make a diagnosis, particularly in patients with hepatic encephalopathy. CASE SUMMARY A 38-year-old man with a history of alcoholic liver cirrhosis presented with altered mental status;the initial diagnosis was hepatic encephalopathy. Although optimal treatment for hepatic encephalopathy was administered, the patient's mental status did not improve. A final diagnosis of NCSE was made by continuous electroencephalogram (EEG) monitoring. Treatment with levetiracetam and propofol pump was immediately started. The patient’s consciousness gradually improved after discontinuation of propofol therapy, and no further epileptic discharge was observed by EEG monitoring. After 1 wk, the patient returned to full consciousness, and he was able to walk in the hospital ward without assistance. He was discharged with minimal sequela of bilateral conjunctivitis. CONCLUSION In cases of persistent altered mental status without reasonable diagnosis, NCSE should be considered in hepatic encephalopathy patients with persistently altered levels of consciousness, and EEG monitoring is very important. We also recommend propofol as a safe and efficient therapy for NCSE in liver cirrhosis patients.

Nonconvulsive status epilepticus disguising as hepatic encephalopathy

Nonconvulsive status epilepticus has become an important issue in modern neurology and epileptology.This is based on difficulty in definitively elucidating thecondition and its various clinical phenomena and on our inadequate insight into the intrinsic pathophysiological processes.Despite nonconvulsive status epilepticus being a situation that requires immediate treatment,this disorder may not be appreciated as the cause of mental status impairment.Although the pathophysiology of nonconvulsive status epilepticus remains unknown,this disorder is thought to lead to neuronal damage,so its identification and treatment are important.Nonconvulsive status epilepticus should be considered in the differential diagnosis of patients with liver cirrhosis presenting an altered mental status.We report a case of a 52-year-old male with liver cirrhosis presenting an altered mental status.He was initially diagnosed with hepatic encephalopathy but ultimately diagnosed with nonconvulsive status epilepticus by electroencephalogram.

Ictal-interictal continuum:a review of recent advancements

Continuous electroencephalogram(cEEG)has become an indispensable technique in the management of critically ill patients for early detection and treatment of non-convulsive seizures(NCS)and non-convulsive status epilepticus(NCSE).It has also brought about a renaissance in a wide range of rhythmic and periodic patterns with heterogeneous frequency and morphology.These patterns share the rhythmic and sharp appearances of electrographic seizures,but often lack the necessary frequency,spatiotemporal evolution and clinical accompaniments to meet the definitive criteria for ictal patterns.They may be associated with cerebral metabolic crisis and neuronal injury,therefore not clearly interictal either,but lie along an intervening spectrum referred to as ictal-interictal continuum(IIC).Generally speaking,rhythmic and periodic patterns are categorized as interictal patterns when occurring at a rate of<1Hz,and are categorized as NCS and NCSE when occurring at a rate of>2.5 Hz with spatiotemporal evolution.As such,IIC commonly includes the rhythmic and periodic patterns occurring at a rate of 1–2.5 Hz without spatiotemporal evolution and clinical correlates.Currently there are no evidence-based guidelines on when and if to treat patients with IIC patterns,and particularly how aggressively to treat,presenting a challenging electrophysiological and clinical conundrum.In practice,a diagnostic trial with preferably a non-sedative anti-seizure medication(ASM)can be considered with the end point being both clinical and electrographic improvement.When available and necessary,correlation of IIC with biomarkers of neuronal injury,such as neuronal specific enolase(NSE),neuroimaging,depth electrode recording,cerebral microdialysis and oxygen measurement,can be assessed for the consideration of ASM treatment.Here we review the recent advancements in their clinical significance,risk stratification and treatment algorithm.