Changes in brain metabolism after ECT-positron emission tomography in the assessment of changes in glucose metabolism subsequent to electroconvulsive therapy--lessons, limitations and future applications.

BACKGROUND: Electroconvulsive therapy (ECT) has been used as an effective treatment option in severe and treatment resistant cases of depression for decades. However the mode of action of ECT is still not fully understood. Advances in neuroimaging created new possibilities to understand the functional changes of the human brain. METHODS: Literature review of studies assessing possible changes in cerebral glucose metabolism pre- and post-ECT by PET, identified by PubMed. RESULTS: Studies were limited by small sample size, inhomogeneous study population with uni- and bipolar depressive patients and methodological inconsistencies. Despite considerable variance, reduction in glucose metabolism after ECT in bilateral anterior and posterior frontal areas represented the most consistent findings. CONCLUSIONS: Future research into this issue should include larger and more consistent cohorts of patients. Assessing clinical improvement of depression after ECT should allow to correlate changes in brain glucose metabolism with functional scores. Follow up PET scans after six or twelve months should be performed to test if changes in brain metabolism are persistent.

Sexuality in multiple sclerosis.

Sexuality and partnership have an important influence on the quality of life of every person and also on people with chronic disorders such as multiple sclerosis. The findings in literature show high evidence that people with multiple sclerosis experience high levels of sexual dysfunction, most of them with hypoactive sexual behaviour often associated with dissatisfaction in relationship, and also the partners seem to show lower sexual and partnership satisfaction. The most common problems in women are lack of sexual interest and decreased libido, often with problems in orgasmic capacity, while men report erectile dysfunction and also lack of sexual interest. The impact of the level of disability and duration of the illness remains unclear. Positive familial support can often help the patient in coping with the illness, nonetheless problems with changing roles and multiple-sclerosis-minimizing can improve the need of contacts to outstanding persons.