INTRODUCTION: A high seizure threshold (ST) is an impeding factor in certain patients, potentially preventing a successful electroconvulsive therapy (ECT) treatment. Several pharmacological and non-pharmacological methods have been put forward to augment ECT in such patients, however, to this date, only a handful of case reports existed about the potential role of repetitive transcranial magnetic stimulation (rTMS), as an augmentation method. OBJECTIVES: and Methods: In this randomized, double-blinded, sham controlled study, we set out to test the hypothesis of whether the application of high frequency transcranial magnetic stimulation (HF rTMS) lowers the seizure threshold for electroconvulsive therapy and whether it has an effect on other aspects of ECT treatment, such as seizure duration (SD), efficacy and safety. RESULTS: 46 patients treated for a major depressive episode, indicated for ECT, were recruited to this study. A significantly lower seizure threshold was observed in the experimental group during ECT titration, on average a decrease by 34.55%, from 34.23 mC to 22.4 mC, p < 0.001 (Wilcox test). We had not observed a significant effect of TMS stimulation before ECT on seizure duration or clinical outcome. Another potentially important observation of this study is that 4 patients in the experimental group developed transient symptoms of hypomania/mania, all of which were stabilized after the combined stimulation protocol was halted spontaneously within a week, without the need to administer mood stabilizers. CONCLUSION: It is likely that HF rTMS stimulation prior to ECT is a novel and simple way of reducing the ST, which is useful in certain groups of patients undergoing this important treatment modality.

• Klíčová slova
• ECT, Seizure threshold, TMS,
• MeSH
• antikonvulziva terapeutické užití   MeSH
• depresivní porucha unipolární diagnóza   patofyziologie   terapie   MeSH
• dospělí MeSH
• dvojitá slepá metoda MeSH
• elektrokonvulzívní terapie metody   MeSH
• lidé středního věku MeSH
• lidé MeSH
• následné studie MeSH
• neparametrická statistika MeSH
• transkraniální magnetická stimulace metody   MeSH
• záchvaty diagnóza   etiologie   patofyziologie   MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• randomizované kontrolované studie MeSH
• Názvy látek
• antikonvulziva MeSH

We demonstrate the feasibility of lowering the seizure threshold using a combined approach of electroconvulsive therapy and transcranial magnetic stimulation. High-frequency transcranial magnetic stimulation of the supplementary motor area shortly before each electroconvulsive treatment session resulted in a reduction of the seizure threshold by half in a male patient with a severe psychotic depressive episode of bipolar affective disorder.

• Klíčová slova
• Adverse effect, Lowering seizure threshold, RUL ECT, TMS pre-stimulation, Ultra-brief pulse,
• MeSH
• bipolární porucha komplikace   terapie   MeSH
• elektrokonvulzívní terapie metody   MeSH
• lidé MeSH
• senioři MeSH
• transkraniální magnetická stimulace metody   MeSH
• záchvaty patofyziologie   MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• Publikační typ
• dopisy MeSH
• kazuistiky MeSH
• práce podpořená grantem MeSH

A brief period of aphasia is an extremely rare and likely underreported adverse effect of electroconvulsive therapy. Clinical studies that have described this phenomenon are scarce and its prevalence is unknown. We present a unique case of a 35-year old woman, who underwent an outpatient ECT session at our department, followed by a short span of aphasic symptoms, the extent of which were monitored clinically and via the czech version of the Minnesota aphasia screening test.

• Klíčová slova
• Adverse effect, Aphasia, MASTcz, RUL ECT, Ultrabrief pulse,
• MeSH
• afázie etiologie   MeSH
• dospělí MeSH
• elektrokonvulzívní terapie škodlivé účinky   MeSH
• lidé MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• ženské pohlaví MeSH
• Publikační typ
• dopisy MeSH
• kazuistiky MeSH
• práce podpořená grantem MeSH