Definition of seismotherapy

Seismic therapy or electroconvulsive therapy (ECT) is a method of treatment with electricity. It consists in passing an alternating current between two electrodes placed on either side of the patient’s skull in order to create a generalized convulsive seizure, or epileptic seizure, having therapeutic effects. It takes place under general anesthesia in order to curb the side effects of this potentially dangerous convulsive crisis for the patient.

The main principles of seismotherapy

Seismotherapy is based on this physiological phenomenon: during a convulsive crisis, by defense and survival reflex, the brain will secrete various neurotransmitters and neurohormones (dopamine, norepinephrine, serotonin) involved in mood disorders. These substances will stimulate neurons and promote the creation of new neural connections. Seismotherapy thus makes it possible to improve neurogenesis, that is to say the number of neurons and the connection between these neurons, notably via a multiplication of synapses and dendrites.

This is the same principle used in electroshock in the past, but in an environment and conditions that are much more secure for the patient since he is placed under anesthesia and curare.

According to the recommendations, seismotherapy can be used as a first-line treatment when there is a vital risk (risk of suicide, serious deterioration in general condition) or when a patient’s state of health is incompatible with the use of a another form of effective therapy, or as a second-line treatment after the failure of a standard pharmacological treatment, in these different pathologies:

• major depression;
• bipolarity in acute manic attacks;
• certain forms of schizophrenia (schizoaffective disorders, acute paranoid syndromes).

However, not all establishments practice seismotherapy and there is a strong disparity in the territory.

The short-term curative efficacy of seismotherapy on major depression has been demonstrated in 85 to 90% of patients, ie an efficacy comparable to antidepressants. Consolidation treatment is required following seismotherapy treatment due to the high rate (35 and 80% according to the literature) of depressive relapses in the following year. It can be drug treatment or consolidation seismotherapy sessions.

Regarding bipolarity, studies show that seismotherapy is as effective as lithium on the acute manic attack in patients receiving neuroleptics, and allows to obtain a rapid action on agitation and elation.

Course of a seismotherapy session

Seismotherapy can be practiced during hospitalization or on an outpatient basis, in one of the establishments practicing this therapy. It requires the presence of a psychiatrist and an anesthesiologist.

A preliminary consultation with the anesthesiologist takes place in order to rule out any contraindication to general anesthesia.

The patient’s consent is mandatory, as with any medical act.

The patient should be fasting with an empty bladder. He is put under short general anesthesia (5-10 minutes) and curarization: he is injected with curare, a substance causing paralysis of the muscles. This helps prevent muscle convulsions and prevent the patient from injuring osteo-articular and dental.

The psychiatrist then places different electrodes on the patient’s skull in order to be able to monitor his brain activity throughout the procedure. Then repeated electrical stimulation of very short duration (less than 8 seconds) of a current of very low intensity (0,8 amperes) are delivered in order to cause a convulsive seizure of about thirty seconds. The weakness of this electric current avoids the serious side effects previously observed after electroshock.

The patient is then transferred to the recovery room. He usually wakes up a little confused, but without any pain. Seismotherapy is indeed a painless and very well tolerated treatment. Some patients may experience headaches after treatment. A light analgesic treatment will then be prescribed to them. After a monitoring period of a few hours, the patient can return home or to his room or hospital, if he was hospitalized.

The sessions can be repeated 2 or 3 times a week, for cures ranging from a few sessions to about twenty, depending on the evolution of the patient’s state of health. Each patient responds differently to this therapy, which requires real personalization.

The risks

Seismotherapy does not cause brain connections, but some risks persist. The risk of mortality associated with general anesthesia is estimated at 2 per 100 seismotherapy sessions, and the morbidity rate at 000 accident per 1 to 1 sessions.

The main undesirable effects are memory loss, which is reversible after stopping seismotherapy sessions.

Electroshock, or convulsive therapy, was used in psychiatry from the 1930s. The technique was developed by the Italian psychiatrist Ugo Cerletti (1877-1963).