http://exhibits.library.stonybrook.edu/mfp/files/original/83ab48a2c2deaa99207d2c9a9f5a4a5d.pdf 5d4afa38e2ad19bfcb3084fe8746be25 PDF Text Text 111: 9/55 Egbert I» Kuhn, mm. Hillside Raspiul, Glen Despite ”posted attomptn, wmlatiam am, my Ia‘rk between aim we activity dwed by «hammock and subsequent. therapeutic outcome haw ham Email, mrtain ahock therapy indum alterations in the sleetmncophalogm in all subjects. mamas voltage whim wmmuml. conclusions are wan-entree! Iran previous studies (1).- Electra:- Three pattema we generally dowribad: ‘1) slowing of tha 2) the in- may of mam, symtria awn {remiss} 51w wave activity, generality a: high appear as burnt nativity) and 3) didnu‘him cios in rate and amplitude. mm in din-act. a at beta rm;— relatim human 12m degree or Mg”, and the number and imam a! mama. In my subjoéts ”mum paint at change is daaeribod, which can be maintained by further those a. tmamnt, but which is apparently not increased. Such indueod oloatroenccpmlu ographic ehangaa are ﬂux-aims. to the pretreatment lswls is number, frequency and Another area than type m ate at“ return at the: cem’bml generally 1 to h weeks, dcpending mhﬁmﬁhip between dagraa of manifest and authors is the the ha}: of direct wry loss and aonfusim and the degree of electroencephalogmphie abmmlity. wry changes with few tmamants and without. Cases are demribed of 3mm significant olaetmncaphalogmphic mm without manifest clinical ﬂange; and also a: never: changes in cerebral emmnicn cf inpaimsnt. In these reports, ganic dimam an at tmtnen‘b. a! agreement ”mg the wry patterns it is? stated that Wim also correlates poorly with clinical results. Hammad at tbs Eastern me Society, Bethesda, September 30, 1955» mach or» ��Whﬁla and EEG these twa “mommy, atuéies dananatrute a ralatianship betwaen clininal ralult tho majority 91’ reports fail to do m. It 3.8 mt 11h]: that this diucrupanay is tha mosult a: diifarunt populatiana, but rather; tun dimer-macs in methods of evaluating Swami, than him at Matias; and diffexunaea in ontinnting change: in aarubrul runntian. In in» ﬁgurae at stuﬁias a! alﬁarnd twain tunetian indueed by at elsatma— in SW Yak, further data m the mkﬁiamhip betaaun EEG ahangea aaa clinical atfoeta of aluetrenhoek wars colleetcd. ’lhs genaral reaulta a: pruviaun investigatiena an the alteratienn in tho EEG with shank this 311137149 Hospital taro anniixnnd, but 313a, a ﬁatinite rmlatianahip betwaan.ﬁﬂﬁ effects and has clinical rasult was dnmnnstratod. Throa £661 are preaanted alaetmeshock today: (1) the m pattem mum electroshock and their “hum to in- pwavument. (2) The internorrelatianl at airfarant quantitieatians at ddlta acttvity. (3) m relation of these abaemtiam to a theary at abet whim. :'vzvﬁhgggggga§§§y Ihuntvmfaar aanaegutava patianta ratarrea for aleetre— 3 shock wart studied. Electruanczgu:.m¢~q us ' 5 warn nan: priar ta traatmant, at uaokly intsrvala ﬂaring traatment aha grist treatment. In 8 ehanns1_ﬂhdcra£t instrunsnt, uaodlo eloatrudus, and bipolar racording Hypervnntilaxdan was tha anly was unad. activatian tachnic utilixoé. truatnant, raaarda ware takna tbs day'attor; ganamully 25 to 31 hunts Datum: after traatmnnt. Th3 Baiter and the tmmnta wen administered by the staff paychia‘bris’m, 6 h? electrnatinulator. Treatment scheéulas namber of treatmants variad tram impruvemant, the 9 to 33. warm An thrae wing a. timma a'waek; patianta shaved alinical psychiatrist tended ta give raver treatments, and warn widely ��m5:- are mam of the diffieultiea in evaluating impmvmnm More might have «momma in the estimates of change in those patients. In any me, by E‘o wing this threefold clusifieatiem, the diffemooa between the groups will be distinct. 9E gag EVALUATIOX first and third W! A total. of 160 meow: were obtained in these who Following the suggestion of Strauss (h), the delta mm am determined for three: lead mmbinetiam (frontal—swam, anterior temporal - vertex, and lobe) for 180 ascends of Hoarding for not load. The delta index :13 on the pemont time woupiod by aerate. ”ﬂame mm of '3 ops- or slower. Tho avenge delta-dude: for the thm loads,.’md the highest delta may: in my load were the 1mm: and in the final tabulation. waves Sinateneouoly, the record me mad for the almost frequency 1am» tifiea at least twioe in my load; the highs» voltage of any delta may and the duration of the longest beret. cm the basis of those were placed 160 mores in It rank ﬁn indie” order from the of slow wave activity the meordu ngt abnormality to the lawn. The were then divided into 3 groups! a Met. upper thins? high degree abnormlﬂy, and lmat m were .. 1m demo mbmmlitm mum-*3: 1. 0m- nouns show a Mitim aomlntion human early out dugm m; okxomlity and improvement. Thane relationships are demonstrated 11: Slide 1. By utilising sleetroehock, we of troutmt is quantification of slow wave abnormality induced by conclude that snob EEG abnormality induced in the first 3 theme on “mental response. 2.. clinical mm minimums We, and than m clinical Mama for the short tom favorable mot bathroom met each of the eeeh other? indie”, first with the ‘ ��WWW £611.3ng ehetrashock mum is the mault of the emﬁm in the mtiant functim in winch new panama of adaptaum, part». Mae me “when amnamu 1mm thaw 6! dental, my be. of a inﬂame! brain as? WM. that: an. alts-rad milieu of eon-ohm}. a puma-equate for ~ 30W, :1: mmnt. mum as measured by delta abnormality is Ta @115 extent the first part. at the Mates».- ”WWI: many of quantitative far the duaidatian at ”Wm 51‘ 27mm mans studies paint. to the Em 5mm: �mm. 1.. than 39mm Lu Th0 Eleatmmeplulm in Thempim, J. Raw. 8: Kent. 131»... Egg 95.107, 3.9512. Jemph a. and Panelist, maetrie 311w]: 3., Harland, W... Kaufman, and Pincus, 6.: Changes in the 81qumaﬁmlegm and in the ke-mtion at 17 {shoutemida [teeming Enam- 3. shmk mommy af Agitated Mpmvam, Payuhoaom. Had... Qt mm, mm: own in the me Mr Barbiturau Anesthesia mma by Elw£mcanwlsin Mama’s and mm SiWicanee for the Timmy (31‘ E01 3.. m and Olin. Rummy“, g; 26l—280, 1951. mum, h. 8km“; Km: Clinical - at mm. madmaophalogmphie Studies a eomhtim Elwtmmawralegmphie and Anatomic Ganges in Gases with m: 14260, 191th. Hammin, Eel” and him, Rd": Mastic U“ a! Mbaﬁihl 3mm! (“Mm Sodium“) in Ma Brain 31m”, Am. J. Wat" m: 12, m, 6. Fink, 3., Am. J. Psychnti, ' 1953. m,Rental Bead», ﬂu H; and a! Qrmie 7. and Dimse, Org-mm Brain 5. Wﬁ; 19%. as n Diagnostia Sign Baum, at 246—58, 1952‘ W in now-y and Mauser, 3.: 33mm a: Impmmment in Wmhoak, cant. "euraloguu, 1‘? 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Three pltteme ere generally described as 1) the am ”3'“? am of high voltage which pregneeeee to burst activity; the 3) Mutation at but: 3 frequencies in rate and amplitude. There 1e e direct relation between the - of these changes, and the utmtien point of number and frequency ehmge 1e deeeriheé, which meat, but whieh, seemingly, frequeney and the type or is or treatments. In may an be maintained by eebjeeahe further ’6 ‘ treetmt, ship between degree of manifest M0113 memory the cited authors is lees and centueion maneephnlegnphio abnormality. Ceeee ere eited of severe the leek er and mm ‘ the degree of e memory We with significant electroencephalographic (ﬂange; and ﬂeece: aﬁWii..¢m”e in cerebral rhythm without. with“ clinical m Manet memory inpeimnt. In theee zeperte, aphasia in "month" he: on such organic ashram also earmletihg poorly we azmm rem! te , ., not inereeeed. Alec, such electmeneephalegmmw Another area of easement few treatments and without 6:3 7‘ g“3* �PM n2. awn”, homer. Two my be cited which mud n oomlatiem ham clinical improvemnt. Rowland, Halo mud, Kaufman and Peanut: in this 19% study of involutional woman ~( chums in the olectmncophalegm and in the accretion of 17 katostoroida new Electmncaphalognphic oranges wing alien-omen]: ens-251, 19M). and at agitated depreaeion, Paychoum. Hod. Q: a relation bunch changes in their clinical therapy roporbed activity as the disturbed be:havior boom now must, tho 13 cps activity incmaed. So treatment induced bohuviounl immanent, 13 ops activity diminished. with recurrent» of symptm, thorn m.- an increase in the 1 time 13 ops activity. rating scale and the per cent time manly, Mort Pmdnm by Theory of a Bath (changes Eloctroconmlaiw EGT action, we and ”no. of mums in which EEG 13 cps in the ma under Rumbas-ate Amsthaain and Their Significance for the hum cm. Hem-own. 1. 261-280, a relationship hottest: thiepontom manna We: and the recovery process “solicited. to inpmvomant. By that it Both noted that slow irregular in appuranm, could not be ntiatuctorily related mm antivity as new in a routine rcéord and be confirmed the reports 1951) described wan adminlltermg an intravenous aolutian of a barbituuto thmpentone, Roth elicited characteristic changes in the ma titer metroshock in mxy subjcct. Early than waé random irregular claw mu untidty, bilaterally which, with more treatment, increased to a highly We), synchronous, high amplitude delta runs and bursts. The” urn chiefly 2.3 cm, with voltages of 200.350 uv and cantlnuoua durations of 30.80 seconds. Winn the mating mcord cum“: rhythmic: Golta activity, umpontem increased its basic pm» its Imam. voltage and duration, spread Roth believed its urea, and decmuod that than chug" warn rehtod to the a! recovery, although, mo concluded: " Hanover, my development at a typical we cameo does slot ensure memory and 10 a! the 36 pntiontl who am men a mag. rams to me for longer m'tw wreaks. m M "Wu-v- 3‘ ' �~3¢ tmsicnt impmment in album). "lat-d. to tho EEG «mating EEG oondition mom to be pationto. .1: in are correct in W cm in thanmommue aﬂoat it would ammo: with tho seem, 31mg mat. tho of tho patients develop typical changes, that the physiological basis for in- provmnt is acquired by the majority or one»; it. «man in promoting recovery.“ w or' my not pm In the course of studiea of altered brain function induced by electron at this mums. Hospital in New York, further day. on the ”Intimaships betmn EEG chanson and :31ch effects of electroshock were collected. shock The general remain of mum innoMga’oiom on the alterations in the elontmhook mm omﬂmd, but. also, I doﬂnito relationship between on“ attacks and tho clinical remit «immtmted. Throo fooi are presented today: £30 with - m (1) Tho EEG patterns following electroshock and their relation to mpmmt. (2) mo intercormlationl of nativity. mama; qmtifioaumo or down " (3) The rolotion of those obaomtiona to a theory of electroshock I . SUBJECTS ‘ action. w W: prior to treatment. 1 Twentyofour common“ portion“ referred for ehctm» shook were awaited. An 8 and bipolar moording was Elootmnoephalogms channel Madonna instrument , and. Hypomtiution mdlo electrodes, m the only activation technio mod. During ornament. records wore taken on the day treatment, generally 25 to 31 hours after worn don. trauma“ after a. . ��In this group in mt chum amiable or who moan change was transient immanent. 3m amt. impa‘md. of chm ﬂuctuatians in behavior, at tins appearing. appeamd much as they did EV. diffsmd in tha third groups mmm or? 2 - Strauss (Clinical ham. Bruin that by tha and boron. Wu In w of the difficulties in evaluating impinmeﬁ'o. aa’oimataa of w H111 be A in than patients. change cam, by using this thmefald classiﬁmtim, firlt and sown pnuanu shaved only equivocal or But the ammo was not sua’oainod, no tm¢mnt, they We are “are might. have plum ware distinct. total at 160 thus 11001113 differences botmn the mm obtained in than manta. Following the maggostion or Dr. Rana me! mctmmphubgmc Studies Garrolations a! «.- Electmneophalogmphiu and Antonia chanson in Cases with Organic Dim. Al. J. Payout“... 3&1: hz—so. 19%); the delta ind»: :19th for thm lads (twahlupuriem. anterior tampon)... vortex. «comm of renaming for own land. The and puriﬁed-aunt love) for 180 don: mm is deﬁned an the ﬁgment. slmr. 1m m tin maupiod by waves or 7 tsp: daluninéex for the three loads, and the: highest in my 1nd ware ten mm: and in the final tabulntiom The average or c1011» Simultmebunly, tho ruéorci was scanned for the slowest freqmncy m imuﬁod M. lean twice wlta Have; ed, but ivity, m in my load; the highest voltage of my and. the ruration 01’ the longest burst. %er aspect: recordwe! in m final Malawian, worn m mgulamy of ham act.- aim of Alpha activity“ and um degm fraqmciu and amplitude of fast activitiea. “than indie” ‘14 net land study; Qua Inn «mm diam not. by thumb": to statistical meow. Fat amounts." mm identifiablo in all tho the clinical administration of barbiturates. A: thin ' ��07‘! Similar mm» or the relation at nah or the: Macs and minim mm mm mm. be tho group cum than boron. Slide 2 mmmmlaumormauummmmwmt. 1‘1»me result. the much upmd group Jump! to cut-1y lam-wad and unimpmvod group: mm: a by tho 10-12 10—80% A 52:: by tho 7-9 m 1123mm tmtmntz mm gnaw, alum - the #0 tmamm. ‘ similar out or our”: is demonstrated in 511603 for the man um delta 1:: am 1nd. In tho nut. slide the man ﬂaunt Imam in recorded, ma this ahm tho am aigniﬂunt nhﬂomhipl. Whiz. the mania imprond highest too ‘ pox-«em. patients than delta waves dam to 3 61:! or I.” by the «com! we]: or tmtmnt, th- at)»: two groups mm: man h 03:: by my fourth wok cf tutti-oat. and; The S and: improved group tho fourth the much new by show highar mm... by the not the elitism: Madly, slide 6 Vat «minim for tho mean highest amntndu chm the am are ”mam far :11 three groups. manta the mean aunties: of bursts. 111 (nu-ﬂint}. In than ml: of Hot noted long bun-at” treatment. Burnt: m no less ”mg. m. wave neural more than 7 {remnant in W m significantly 9119er hen, the is the fact” or “gummy of hm“. £91m!- rmthntly mm more maul“ in troqmcy “plum!” than in the other We groups; than studio: my be interpmud u demonstrating that manure: of slow and The patient: lbw longer hunts, winging 1W tho third unimprmd and modes-«uh inpmvod groups and and mm: mm: and by activity aria from the «wk 01‘ than am myuological pm”, m «imam in ablation to the diaturbmoos in earn-bun. function induhd by elactmahock. �3. ﬁnally, can these alterations in npoets of «tubal function mid: In tho» undies, the myriad. 1mm: current-d with own:but been altered by olectroshaok? mama af «tubal function were assayed- tut or Weinstoin and m um 01' double stimulation and tom text showed a W test thus EEG. 013110? any m we ho of tan. In than ation of intuvumu memory and mum” sodium until. racing. 0: than threw indies», only correlation with the subject simultaneous is interviewed 1.21th and can and’ qmatiom of orient- mm, the quantum an reputed errors in orientation, mnfabuhuan, dank). at 3.11am: and rsduplicauon are mud n 'poaitiw' myul tut, and are indicatiw of cerebral wilful-mum; Comet roman to than qmstim after and an a ‘mgatiw' W'm “at. In the wt click, #7. the pox-0mm positivc mm tom are 4 , m wanna. botmn tn. cmpund for meat. me much in titanium. of the m1. gmupa, with the number or weeks ovary patient much improm and at trut- m other tam gram . in the and: improved group had u positive mm by the third weak a! mama, m m abnomaiity panama; in tho unimproved swaps only me patimm had a positive as tram-£19m «opus command mam-m. In 311d. high degree 8. the an relation between, 1‘ EEG abnomlity shows a maul? The“ . ’ tinntmaus tactile tom inclines alarm). maxim and tho distinct carnation which in autism tinny signifiemt. Hint of tho an m1 and thin ahmd no won-elation with mama’s, it. can be concluded that tutu of wry and impromt. In an: and the than are axiom! typo. of mmbml dam- m cannot. speak in gm tom 9! g hrk a! comhum batman m m and 00me dyarnncum or organic payment, function tad taut �‘9. this point I should like us muss m findings and mass thoughts as to thsir significance for s theory or electmshoak mm. At. m moss is 11m. doubt that eloctmshwk m. It 3.: all upmsds to almr, symwio, We. induces delta nbnomnty 1:: tbs may frontal, but with Mmamrtmmm, With immune trusmt thaﬁsqmncios beam the smplitudu higher, tho bunt activity longer sad more regular. mile den: sbnomlity is pussnt in every mpord “ﬁr olsctmhock, its Roth‘s mum‘s mammg Manning emu .mmw «gm 9.: with bat-bum“ are Digniﬂmt 1n pmﬁmg the 11m” emu Mum by «wk. furthsr slntroahwk. In sans subjects sanity is not. induced despite atoms.” Our aux-relations of Guam 0!." test, um s meeasary chm-"u fail to wear in the tram. delta ammlity with 13pm srs «:1»th thorium. significant far tbs ”amiss: o: alteration in cox-ohm function as mm War, a high dogma «hits smorAn early, autumn mm by the EEG, and (and in the m1 taut), also by m. ' pmummﬁSiM for improvemt. when such EEG H u sign- nificmt clinical improvement V111 rail to wear in the patient' a hshs'dar. with wry loss, points Tbs rm. that than camlatiws mm not to the poasihiuty that. this is not a significant master in improvement. In conclusion, than studs.“ land uppers to s theory at E8? action moﬁntly unwanted by Gamma sud can at us (Kuhn). Thou “at ‘ authors postulstsd that wwwmt fanning olactroshoek is than malt of tbs amtion 1:: tbs patient 91' a min at altered brain function in much now puttéms or mputim, a-srtioulorly mm a! denial; my be main-- mm. mm m nudist Winn that :5 «land milieu of «avatar-J. museum u assured by mu abnormality is ,s pm~mu1s1u for improvisamt. ‘ro this extent the first. part. of ﬁns unseen-am Wall is ’“PPGTst �% m W, mm «was: m- studs.» punt to ﬂuaiﬁﬂﬁim of m “grammar of quantum" Wm at mum ' �Dr. Joseph S. A. Miller. To: From: Dr. Max Fink May I have your approval to submit this technical paper to the Eastern EEG Society for its October meeting in Bethesda ? ��mmmMmmwmtmmam mm m m mum as? (3) a» in mm. warm “at m m a: m mam a: mm mm: mwvm mmmmymmm mm,mzm �112:? My) Quantitative Studies 2;: Slow Wave I M 9/5"!» Activitz Following Electroshock Max Fink, HOD. Robert L. Kahn, PhoD. Hillside Hospital, Glen Oaks, New York Despite repeated attempts correlations between slow wave activity induced by electroshock and subsequent therapeutic outcasts have been unsuccessful. Howconclusions‘pfrom W; ”avg/a... rewart-m previous studies?“ "W Wm“ Ail—pam- over, certain mduuo are Electroshock therapy suffer alterations in the electroencephalogram«a»‘ﬁz 9%.- . 3m Three pattems are generally describedzu l) b slowing of the alpha frequen- cies; 2) the appearance of random, synmetxic slow wave activity, generally of; activity, and 3) diminution of beta frehigh voltage which Wﬁbwburst quencies in rate and amplitude. There is a direct relation between the degree of these changes, and the number and frequency of treatments. In many subjects a saturation point of change treatment, but the pretreatment levels mnnbe r, described, which can be maintained by further is which” are reversible. Qfﬂdeef Mir. not increased. The ographic changes the is «he, we!“ c,at!” 5mm electroencephal- rate of return of the cerebral patterns to is generally l to b, weeksxgﬂ’ipending directly ugh- on frequency and the type of treatment. cited authors is the lack of direct relationship between degree of manifest memory loss and confusion and the degree Another area of agreement among the of electroencephalographic abnormality. Cases are describedgevere memory changes with few treatments and without significant electroencephalographic change; and also of severe changes in cerebral or memory impairment. In these reports, Weclinical is correlatgug poorly With organicconfusion also Presented at the Eastern E E W rhytlmls without manifest 0 Society, Bethedda) -~-- clinical confusion > Md “HA0? 8 such gM’Y’EJ results. - Septembee 30, ”0...... «.~.—.._._,___...~—-— 4...“ ._.... 195? �Two studies, however, may be cited as noting a correlation between ectro- u: encephalographic changes and clinical improvement. Hoagland, Malamud, Kaufman rt- ﬁdand Pincus in their l9h6 study of involutional L’ women ‘1) - tonnage-MW: reported a =§W19§9+ relation between changes in their clinical rating scale and the per- cent time 4'40 W61 131, ‘ctivity. more than 3.2% activity increased. cw activity diminished. % A time 1301;: a More As treatment induced behaviojral improvement,—-B=eps tivity.C3,) Roth ﬂ" there was an MK, increase in the . Mow-W .--__ , WWW-WBW‘UI relationship msngmmeWeWw5M— the Mby. ~. the disturbed behavior became more manifest, the With recurrence of symptoms, e WA recently, As . 1 described a between thiopentone induced EEG changes and recovery process. Roth noted that slow wave activity as seen in a routine post-shock record was irregular in appearance, and he confirmed the reports that it could not be satisfactorily m , related to improvement. the However, by administering an intravenous thiopeﬁ‘tone, he elicited characteristic changes solution of in the EEG after electroshock in every subject. Early’there was random irregular slow wave act- ivity, whichyéith increased to a highly rhythmic, bilaterally more treatmen synchronous, high amplitude delta runs and M ILKoVol'PS bursts. These were with voltages of 200-350 is and continuous durations of 30-80 seconds. When its the resting record evinced rhythmic delta activity, thiopentone increased voltage and duration, spread its believed that these changes were m F4» lemma; chiefly 2-3 area, and decreased its basic frequency. related to the process of recovery, and Both v �he concluded: “The development of a typical and 10 of the 36 patients who attained such a than two weeks. But transient improvement related to the ing the EEG EEG change does not ensure recovery failed torsmit for longer in clinical condition seemed tolae change in these patients. changes with the therapeutic effect it EEG change even If we are correct in connect- would seem, since most of the patients develop typical changes, that the physiological basis for improvement is acquired by the majority of cases; it may or may not prove effective in promoting recovery." Whileathesettwoﬁstudiessdemonstrate a relationship between clinical result and EEG abnormality, the majority of reports fail to do so. It is not likely that this discrepancy is the result of different populations, but rather, the differences in methods of evaluating improvement, the time of evaluation, and differences in estimating changes in cerebral function. In the course ofestudies of altered brain function induced by electroshock at the Hillside Hespital in further data on the relationship! be~ tween EEG changes and clinical effects of electroshock were collected. The general results of previous investigations on the alterations in the EEG with New York, electroshock were confirmed, but also, a definite relationship between effects and the clinical result was demonstrated. Three EEG foci are presented today: (1) The EEG (2) The patterns following electroshock and their relation to improvement. intercorrelations of different quantifications of delta activity. (3) Athe relation of these observations to a theory of electroshock action. SUBJECTS AND METHOD: Twenty~four consecutive patients referred for electroshock were studied. Electroencephalograms were done treatment, at weekly intervals during treatment and after treatment. prior to An 8 channel �.5‘ but the dramatic in the change so evident patient continued to first group was not apparent. Each noticable disturbance such as obsessional think- show some ing, paranoid ideas, or somatic preoccupation. C. whom Minimalyy or Unimproved: In this group were placed seven patients in change was not clearly noticable or who showed only equivocal or improvement. improved. Some showed transient fluctuations in behavior, at times appearing But the changes were not sustained, so that somewhat by the end of treatment, they appeared.much as they did before. we are aware of the difficulties in evaluating improvement. Others might have differed in the estimates of change in these patients. In any case, using this threefold classification, the differences between the third groups will be by first and distinct. EVALUATION OF EEG RECORDS: A total of jects. Following the suggestion of LJ.aPsychiatemgggnehZ-Sewwl9hhd, w 160 records were obtained in these subStrauss the delta index was determined for three lead (frontal-parietal, anterior temporal - vertex, and parietal-ear lobe) for 180 seconds of recording for each lead. The delta index is defined combinations as the perbcent time occupied by waves of 7 cps or slower. The average for the three leads, and the highest delta index in any lead indices used in the final tabulation. index Simultaneously, the record was scanned delta- were the for the slowest frequency identified at least twice in any lead; the highest voltage of any delta wave; and the durb ation of the longest burst. (V) �Ch. Medcrart instrument, needle electrodes, and bipolar recording was used. Hyperb ventilation was the only activation technic utilized. During treatment,:records were taken the day after, generally 25 to 31 hours The treatments were administered by the C h? electrostimulator. number of treatments after treatment. staff psychiatrists, using a Reiter Treatment schedules were three times a week; and the varied from 9 to 33. As patients Showed clinical improve- ment, the There psychiatrist tended to give fewer treatments, and more widelyfspaced. were 15 women and 9 men in the series, and ages ranged from.2h to 68 with a median of h7. EVALUATION QE CLINICAL RESPONSE: All the patients eight were observed for at least after termination of therapy. determined on the basis of the res- weeks patient's reaponse to electroshock was ident psychiatrist's impression, staff opinion, the nurse's notes and the clinical evaluation of the supervisor in charge of electroshock. The patients were The divided into three groups A. Markeglz ggproved: ~ markedly improved, moderately improved and unimproved. The 11 cases in this group were regarded as showing recovery or marked improvement. These patients no longer showed the which brought them symptoms into the hOSpital; their doctors felt they were better; and the nurses' notes confirmed such aspects as being able to sleep without medic- ation, better appetite, and improved capacity to get along with the other patients and participate in hospital activities. six patients in this group showed some improvebut continued to manifest indications of mental illness. These patients B. iModerately ggprove : The ment typically Showed symptomatic relief, i§,, acute depressive features might be gone, �On the basis of these five indices of slow wave activity the records placed in a rank order from the greatestabnormality to the lowest. cords were then divided into 3 groups - g uﬁbr were The 160 third - high degree EEG re- abnorm- ality) and lowest third =£w degree abnormality. RESULTS:1.0ur results show a positive correlation between early high degree EEG abnormality and improvement. These relationships are demonstrated in Slide I. utilizing these quantifications of slow wave abnormality induced by electroshock, we conclude that such EEG abnormality induced in the first 3 weeks of ‘By is treatment an essential pre-requisite for the short term favorable clinical response. 2. What relationships exist between each of the indices, clinical response, and then / amongst each first with the other? Similar analyses of the relation of each of the indices and clinical result identical curves to the group curve shown before. Slide 2 shows the relation of the delta index to improvement. The mean index in the much im- showed proved group jumps to 52% by the 7-9 treatment; while the moderately improved and unimproved groups show a gradual, slow increase to 10-20% by the 10-12 treatment. A similar set of curves id demonstrated in slide 3 for the mean highest percent time delta in one lead. In the next shows the show delta other two Slide same slide the slowest frequency is recorded, significant relationships. While the and this) tbo/ much improved patients to 3 cps or less by the second week of treatment, groups Sarely reach )4 cps by the fourth week of treatment. waves down 5 shows the same much improved group show week the mean correlations for the mean and- *{e highest amplitude, the higher voltages by the second week and by the fourth differences are persistent for all three groups. �Finally, slide 6 shows the duration of bursts. mean The records of the much Improved patients third treatment. Bursts are less frequent in the unimproved and week of show longer bursts, averaging more than 7 seconds by the mod- erately improved groups and are significantly shorter in duration. not noted here, however, is the factor of regularity of bursts. In the longer bursts, wave forms frequently were more regular in frequency and amplitude, than in the other two groups. These studies may be interpreted as demonstrating of slow wave activity arise from the same that each of these measures physiological process, and assume the significance in relation to the disturbances in cerebral function induced by electroshock. same I 3. Finally, can these alterations in the pects of cerebral function which EEG may have been be correlated with other ap- altered by electroshock? In these studies, three other indices of cerebral function were assayed - the amytal test of Weinstein and Kahg? tests of double simultaneous tactile stim- ulatioaj and tests of amytal test showed a memory and recalfz) Of these three indices, only the positive correlation with improvement and.with the EEG. results were presented recently at the American Psychiatric Association we will forgo a discussion at this time. ‘93 __,wle These and It.;::; suffice demonstrates the correlation berel éF, tween the amytal eating and the high degreerhEG abnormality. n—v_ this iigﬁgLshows ﬁb£ that the next slide, # 7 ' , distinct relationship between the two factors. At this point I should like to summarize our findings and express some thoughts as to their significance for a theory of electroshock action. There is little doubt that electroshock induces delta abnormality in the EEG. It is a symmetric, chiefly frontal, but with increasing treatment, spreads to all leads. With increasing treatment the frequencies became slower, the amplitudes higher, the burst activity longer and more regular. in every record after electroshock, its ‘While degree delta abnormality is present is variable. Roth's experiment's �~8- inducing increasing delta abnormality with barbiturate are significant in predicting the later changes induced by further electroshock. In some subjects however, a high degree delta abnormality is not induced despite extensive treatment. correlations of degree of delta abnormality with improvement are also significant for the theory of the mechanism of electroshock. An early, SusOur tained alteration in cerebral function as measured by the EEG, and also by the amytal test, appears to be a necessary pre-requisite for improvement. Where *- in the amytal test), the: the patient's behavior. €l%n ificant clinical improvement will fail to occur in fact that the correlations were not evident with memory loss, points to the possibility that this is not a significant factor in improvement. such changes fail to occur in the EEG (and The In conclusion, these studies lend support )to a theory of EST action recently (Kahn)(.r These authors postulated that enumerated by Weinstein and one of us improvement following electroshock is the result of a milieu of altered brain function in which of the creation in the patient new patterns of adaptation, part- icularly those of denial, may be maintained. These EEG studies demonstrate that an altered milieu of cerebral function as measured by delta abnormality is a pre-requisite for improvement. To this extent the first part of tbs Weinstein-Kahn hypothesis is supported. Secondly, these studies point to the validity or quantitative the elucidation of mechanisms of behavior. EEG studies for �1533 m a???" September 21, 1955 MEMORANDUM TO: FROM: Dr. Soseph S. A. Miller Dr. (1) Max Fink entitled "Quantitative Studies of Slow Wave Activity Following Electroshock" will be presented at the Eastem EEG meeting at Our paper Bethesda, Friday September 30th. (2) May I have permission for Dr. Kahn (the co-author) and myself to attend the sessions of the society? �(new? ' £5)“; saw» 21.. 1955 m! m1 Mamaahamr ”gum (1) our W amt-MM *mpmuu saw» a: 3m 1m Mtiviw (a) lily 1: MWMWﬂnbapWMWMMWmM at whim! is!» ma pammaa tear m». ”aim at the am m (m mama!) and W ta 357‘ �III: Quantitative Studies 2; Slow Wave 9/55 Activity Following'Electroshock Fink, Max MOD. Robert L. Kahn, Ph.D. Hillside Hospital, Glen Oaks, New York Despite repeated attempts, correlations between slow wave activity in- duced by electroshock and subsequent therapeutic outcome have been unsuccessful. However, certain conclusions are warranted from previous studies (1). Electro- shock therapy induces alterations in the electroencephalogram in all subjects. Three patterns are generally described: 1) slowing of the alpha frequencies; 2) the appearance of random, symmetric slow'wave voltage which cies in rate may activity, generally of high appear as burst activity; and 3) diminution of beta frequenThere and amplitude. is a direct relation between the degree of these changes, and the number and frequency of treatments. a saturation point of change is described, to the pretreatment levels The 1 to h weeks, depending directly on the treatment. relationship between degree of manifest memory degree of electroencephalographic abnormality. memory impairment. in cerebral loss and confusion of direct and the Cases are described of severe at the Eastern EEG rhythms without manifest In these reports, ganic confusion also correlates poorly with Evesented is the lack with few treatments and without significant electroencephalographic change; and also of severe changes confusion of further Such induced electroencephal- Another area of agreement among the cited authors memory changes subjects rate of return of the cerebral patterns is generally number, frequency and the type of many which can be maintained by treatment, but which is apparently not increaSed. ographic changes are reversible. In it is clinical stated that such or- clinical results. Society, Bethesda, September 30, 1955. �-2studies, however, Two cited as noting a correlation between may be electroencephalographic changes and clinical improvement. Hoagland, Malamud, in their l9h6 study of involutional Kaufman and Pincus women relation between changes in their clinical rating scale time more than 13 cycles per second activity. and the per-cent the disturbed behavior be- As manifest, the fast activity increased. came more (2) reported a treatment induced behavior- As al improvement, such fast activity diminished. With recurrence of there was an More induced increase in the Roth (3) described a recently, EEG time 13 cycles per second % provement. Roth noted it tone, he elicited characteristic changes in the was random irregular and bursts. w act- wave solution of the thicpen- EEG after electroshock in every slow wave activity, which increased bilaterally synchronous, high with mere treatment to a highly rhythmic, litude delta runs 51 was However, by administering an intravenous subject. Early, there that irregular in appearance, and could not be satisfactorily related to imr ivityas seen in a routine post-shock record reports that activity. relationship between thiopentone changes and the recovery process. he confirmed the symptoms, amp- chiefly 2-3 cycles per second, with These were voltages of 200-350 microvolts.and continuous durations of 30-80 seconds. the resting record evinced rhythmic delta activity, thiopentone increased voltage and duration, spread its believed that these changes were patients than But two weeks. related to the ing the patients EEG EEG transient change even improvement change does not ensure recovery failed to remit for longer in clinical condition seemed to be change in these patients. If effect it we are correct in connect- would seem, since most of the typical changes, that the physiological basis for by the majority of cases; moting recove 1y." EEG attained such a changes with the therapeutic deveLOp is acquired who its area, and decreased its basic frequency. Roth related to the process of recovery, and he concluded: "The development of a typical and 10 of the 36 'When it may or may not prove improvement effective in pro- �.3While these two studies demonstrate a relationship between clinical result' and EEG abnormality, the majority of reports fail to do It is so. not likely that this discrepancy is the result of different populations, but rather, the differences in methods of evaluating improvement, the time of evaluation, and differences in estimating changes in cerebral function. In the course of studies of altered brain function induced by electro- at shock the Hillside Hospital in New York, further data on the relationship clinical effects of electroshock were collected. The general results of previous investigations on the alterations in the EEG with between EEG changes and electroshock were confirmed, but also, a definite relationship between effects and the clinical result was EEG demonstrated. Three foci are presented today: (1) (The EEG patterns following electroshock and their relation to imp provement. (2) The (3) The SUBJECTS intercorrelations of different quantifications of delta activity. relation of these observations to a theory of electroshock acticn. AND METHOD: Twenty-four consecutive patients referred for electro- shock were studied. Electroencephalograms were done prior to treatment, at weekly intervals during treatment An 8 and after treatment. channel Medcraft instrument, needle electrodes, and bipolar recording was used. Hyperventilation was the only activation technic utilized. treatment, records were taken the day after, generally 25 to treatment. The Reiter C 31 hours During after treatments were administered by the staff psychiatrists, using a h? electrostimulator. Treatment schedules were three times a week; and the number of treatments varied from 9 to 33. improvement, the As patients psychiatrist tended to give fewer treatments, showed clinical and more widely �.u. There were 15 women and 9 men spaced. to 68 in the series, and ages ranged from 2h with a median of h7. g3 EVALUATION CLINICAL RESPONSE: All the patients were observed for at least eitht weeks after termination of therapy. patient‘s reSponse to electroshock'was determined on the basis of the resident psychiatrist's impression, staff opinion, the nurse's notes and the clinical evaluation of the supervisor in charge of electroshock. The patients The were divided into three groups - markedly improved, moderately improved and unimproved. A. Markedly Improved: The 11 cases in this group showing recovery or marked improvement. These symptoms which brought them into the beepital; patients were regarded as no longer showed the their doctor felt they were better; and the nurses' notes confirmed such aSpects as being able to sleep without medication, better appetite, and improved capacity to get along with the other patients and participate in hospital B. improvement activities. six patients in this group showed some but continued to manifest indications of mental illness. These Moderately,lmproved: patients typically The showed symptomatic relief, i:g;, acute depressive features might be gone, but the dramatic change so evident in the apparent. Each patient continued to show some first group was not noticable disturbance such as obsessional thinking, paranoid ideas, or somatic preoccupation. C. Minimally g£_unimproved: In this group were placed seven patients in whom change was not clearly noticable or who showed only equivocal or transient improvement. Some showed fluctuations in behavior, at times appearing somewhat improved. But the changes were not treatment, they appeared much sustained, so that by the as they did before. end of �.5are aware of the difficulties in evaluating improvement. Others might have differed in the estimates of change in these patients. In any case, by we using this threefold classification, the differences between the groups first and third will be distinct. 93 EVALUATION delta index EEG RECORDS: was A total of 160 records were obtained in these sub- jects. Following the suggestion of Strauss (h), the determined for three lead combinations (frontal-parietal, anterior temporal - vertex, and parietal-ear lobe) for 180 seconds of recording for each lead. The delta index is defined as the per-cent time occupied by waves of 7 ops or slower. delta-index for the three leads, and the highest delta index in any lead were the indices used in the final tabulation. The average for the slowest frequency idenp tified at least twice in any lead; the highest voltage of any delta wave; and the duration of the longest burst. Simultaneously, the record 0n the was scanned basis of these five indices of slow wave activity the records were placed in a rank order from the greatest abnormality to the lowest. 160 records were then divided into groups abnormality, and lowest third = RESULTS: in Slide 3 - i;g=_upper third= The high degree EEG low degree abnormality. l. Our EEG abnormality and improvement. These relationships are demonstrated results show a positive correlation between early high degree I. utilizing these quantifications of slow wave abnormality induced electroshock, we conclude that such EEG abnormality induced in the first 3 By of treatment is an.essential pre-requisite for the short term favorable by weeks clinical response. 2. What relationships exist between each of the indices, clinical response, and then amongst each other? first with the �~6- Similar analyses of the relation of each of the indices and clinical result identical curves to the group curve shown before. Slide 2 shows the relation of the delta index to improvement. The mean index in the much improved showed group jumps to 52% by the 7-9 treatment; while the moderately improved and un- improved groups show a gradual, slow increase to 10720% by similar set of curves is demonstrated in slide A 3 the 10-12 for the mean treatment. highest percent time delta in one lead. In the next slide the shows the same delta show other two groups to the same much improved group show week h cps by the much improved While the much improved fourth correlations for the week of mean all three 6 shows the mean duration of patients this, too, patients treatment. highest amplitude, the higher voltages by the second week and by the fourth the differences are persistent for Finally, slide and cps or less by the second week of treatment, the 3 rarely readh 5 shows is recorded, slowest frequency significant relationships. waves down Slide mean show groups. bursts. The longer bursts, averaging more than records of the 7 seconds by the third week of treatment. Bursts are less frequent in the unimproved and moderately improved groups and are significantly shorter in duration. Not noted here, however, is the factor of regularity of bursts. In the longer bursts, forms frequently were more regular wave in frequency and amplitude, than in the other two groups. These ures of the studies may be interpreted as demonstrating that each of these meas- activity arise from the same physiological process, and assume significance in relation to the disturbances in cerebral function in- 31 w wave same duced by electroshock. 3. Finally, can these alterations in the pects of cerebral function which may have been EEG be correlated with other as- altered by electroshock? In these studies, three other indices of cerebral function were assayed - the amytal �-7- test of Weinstein and Kahn (5), (6), and tests of memory and tal test showed a positive correlation with tests of double simultaneous tactile stimulation recall (7). Of these three indices, only the amyimprovement and with the EEG. These results were presented recently at the American Psychiatric Association and we will forgo a discussion at this time. It may suffice that the next slide, # 7, demonstrates the correlation between the responses on amytal of abnormality. This graph EEG tests and the degree distinct relationship between the shows a two I factors. this point I should like to summarize our findings and express thoughts as to their significance for a theory of electroshock action. At is little doubt that electroshock induces delta abnormality in the symmetric, chiefly There It is EEG. frontal, but with increasing treatment, spreads to all leads. increasing treatment the frequencies With some became slower, the amplitudes the burst activity longer and more regular. While delta abnormality in every record after electroshock, its higher, is present is variable. Roth's experiment's degree inducing increasing delta abnormality with barbiturate are significant in predicting the later changes induced by further electroshock. In some subjects however, a high degree delta abnormality is not induced despite extensive treat- ment. Our correlations of degree of delta abnormality with significant for the theory of the mechanism of electroShock. tained alteration in cerebral function as measured amytal test, such changes clinical improvement are also An early, sus- by the EEG, and also by the appears to be a necessary pre-requisite for improvement. Where fail to occur in the improvement in the amytal test), then significant will fail to occur in the patient's behavior. The fact that EEG the correlations were not ivident with (and memory loss, points to the possibility that this is not a significant factor in improvement. In conclusion, these studies lend support to‘a theory of enumerated by Weinstein and one of us (Kahn) (8). EST These authors action recently postulated.that �-8improvement following electroshock of a milieu of is the result of the creation in the patient altered brain function in which new patterns of adaptation, part- icularly those of denial, may be maintained. These EEG studies demonstrate that an altered milieu of cerebral function as measured by delta abnormality is a pre-requisite for improvement. To this extent the first part of the weinsteinKahn hypothesis is supported. Secondly, these studies point to the . for the elucidation of validity of quantitative mechanisms of behavior. EEG studies �REFERENCES l. Chusid, Joseph G. and Pacella, Bernard L.: the Electric Shock Therapies, J. Nerv. The Electroencephalogram & Dis., 11g: 95-107, 1952. Ment. Hoagland, H., Malamud, W., Kaufman, and Pincus, 6.: encephalogram and in the Excretion of 17 in Changes in the Electro- Ketosteroids Accompanying Electro- shock Therapy of Agitated Depression, Psychosom. Med., §; 2&6-251, 19h6. 3. Roth, Martin: Changes in the EEG Under Barbiturate Anesthesia Produced Electroconvulsive Treatment and Their Significance for the Theory of Action, EEG by ECT and Olin. Neurophys., 2; 261-280, 1951. Strauss, Hans: Clinical and Electroencephalographic Studies ~ Correlations of Mental, Electroencephalographic and Anatomic Changes in Cases with Organic Brain Disease, So Am. J. Psychiat., 191: and Kahn, R.L.: weinstein, E.A., ("Amytal Sodium") Diagnostic hZ-SO, l9hh. Use of Amobarbital Sodium in Organic Brain Disease, Am. J. Psychiat., 192: 12, 889-89h: 1953. 6. Fink, M., Green, M. and Bender, M.: The Face-Hand Test as a Diagnostic Sign of Organic Mental Syndrome, Neurology, 2: h6-58, 1952. 7. Karin, H., Fink, M. and Kwalwasser, 5.: Relation of Changes in Memory and Learning to Improvement in Electroshock, Conf. “eurologica, 1Q: 88-96, 1956. Weinstein, E.A., Kahn, R.L. and Linn, L.: Peychosis During Electroshock Therapy: 19.9.: Its Relation to the 22-26, 1952. Theony of Shock Therapy, Am. J. Psychiat., �� Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Published Works Text A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text. Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Quantitative studies of slow wave activity following electroshock. Electroencephalogr Clin Neurophysiol. 8:158, 1956. (abstract). Type The nature or genre of the resource Text Identifier An unambiguous reference to the resource within a given context mfp-02-01-001-21a-025 Date A point or period of time associated with an event in the lifecycle of the resource 1956 Creator An entity primarily responsible for making the resource <a title="Fink, Max, 1923-" href="http://id.loc.gov/authorities/names/n79039548" target="_blank">Fink, Max, 1923-</a>; Kahn, Robert L. Subject The topic of the resource Published Works -- Articles and Reviews Relation A related resource The Max Fink Collection Description An account of the resource Several [preprint]s, drafts, and handwritten manuscripts of this title. Three short letters from Fink to Joseph S. A. Miller. 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