Use of the Neuro-Wrap system for severe post-electroconvulsive therapy headaches.

OBJECTIVE: To determine, in a nonblinded trial, if the Neuro-Wrap system is effective in reducing the severity of pain in patients with severe post-electroconvulsive therapy (ECT) headaches not adequately responsive to routine analgesic treatment. BACKGROUND: A very troubling side effect of ECT is severe post-ECT headaches. Although these headaches usually respond to routine analgesic medication, some patients continue to experience severe headache despite treatment. This very unpleasant sensation, repeated with each ECT, may cause patients to prematurely stop ECT and experience a relapse in their psychiatric symptoms. "Cold therapy" has been used for a long time as an adjunct to treat headache and pain. The Neuro-Wrap system is a method to provide temperature-controlled cooling to the head without the need to frequently reapply ice packs or physically hold the ice packs in position. It has been used successfully for patients with migraine headaches. This is the first report of its use with patients experiencing severe post-ECT headaches. METHODS: The study comprised a total of 14 patients receiving ECT who experienced a severe headache for 2 successive ECT treatments or 2 of their last 4 treatments and who had only partial or no response to usual analgesic treatment for their headache. After completion of the ECT, the Neuro-Wrap was placed on the head of the patient for a maximum of 40 minutes. Patients continued to receive analgesic medication as needed for relief of headache pain. Patients were their own control group. RESULTS: A total of 85 Neuro-Wrap treatments were given to 14 patients ranging in age from 23 to 71 years old. Nine patients reported clearly positive results on 67 different occasions. Three reported mild alleviation of headaches on 15 occasions. The remaining 2 patients had a total of 3 treatments with no benefit. After the initial treatment, 12 of 14 patients wanted to use the machine after all their subsequent ECT sessions. CONCLUSIONS: Cold therapy with Neuro-Wrap is an effective alternative treatment for refractory headaches caused by ECT.

In situ reactions of monoclonal antibodies with a viable mutant of Murray Valley encephalitis virus reveal an absence of dimeric NS1 protein.

Studies on the NS1 protein of flaviviruses have concluded that formation of a stable homodimer is required for virus replication. However, previous work has reported that substitution of a conserved proline by leucine at residue 250 in NS1 of Kunjin virus (KUNV) eliminated dimerization, but allowed virus replication to continue. To assess whether this substitution has similar effects on other flaviviruses, it was introduced into an infectious clone of Murray Valley encephalitis virus (MVEV). Consistent with studies of KUNV, the mutant virus (MVEV(NS1-250Leu)) produced high levels of monomeric NS1 and the NS1 homodimer could not be detected. In contrast, wild-type MVEV cultures contained predominantly dimeric NS1. Retarded virus growth in Vero cells and loss of neuroinvasiveness for weanling mice revealed further similarities between MVEV(NS1-250Leu) and the corresponding KUNV mutant. To confirm that the lack of detection of dimeric NS1 in mutant virus samples was not due to denaturation of unstable dimers during Western blotting, a mAb (2E3) specific for the MVEV NS1 homodimer was produced. When NS1 protein was fixed in situ in mammalian and arthropod cells infected with wild-type or mutant virus, 2E3 reacted strongly with the former, but not the latter. These results confirmed that Pro(250) in NS1 is important for dimerization and that substitution of this residue by leucine represents a conserved marker of attenuation for viruses of the Japanese encephalitis virus serocomplex. The inability to detect dimeric NS1 in supernatant or cell monolayers of cultures productively infected with mutant virus also suggests that dimerization of the protein may not be essential for virus replication.

Transcutaneous acupoint electrical stimulation in preventing and treating nausea and vomiting in patients receiving electroconvulsive therapy.

A significant number of patients complain of nausea after general anesthesia and electroconvulsive therapy (ECT). Nausea is second only to headache as the most frequent and troublesome systemic side effect of ECT. The most common treatment of this is antiemetic drugs. Transcutaneous acupoint electrical stimulation (TAES) is a nonpharmacologic method for preventing and treating nausea and vomiting. TAES can alleviate motion sickness, reduce the incidence of vomiting caused by chemotherapy, and treat pregnancy-induced nausea and vomiting. TAES has been shown to reduce the incidence of postoperative nausea after general anesthesia. This is the first report to review the effectiveness of TAES in preventing and treating nausea and vomiting in 11 patients receiving ECT. Nine of these patients had a good response to TAES. One patient had a mixed response, and 1 did not respond to TAES.

Anesthesia for electroconvulsive therapy in obese patients.

IMPLICATIONS: Obese patients have successfully undergone over 650 consecutive uncomplicated ECT treatments without any special precautions at two major U.S. medical centers.