http://exhibits.library.stonybrook.edu/mfp/files/original/adc880b1aeb3dcbe5c3e582845604c89.pdf 08bd5f56dfe8bf9c06a0f4c7d3ccafd5 PDF Text Text November 5, 1979 Richard D. Weiner, M.D., Ph.D. V.A. Hospital Durham, North Carolina 27705 Dear Rich, After a hectic few months, I have finally had the time to read the many reports and papers that have been on my desk since my holidays. Among these, was the report "ECT and Seizure Threshold" as presented at the Society of Biological Psychiatry. The paper is quite good, reflecting many more cases than I thought had been studied. There is little that I can argue with in the data, but there questions inherent in the attitudes expressed. As I understand the study. it is an assessment of two aspects of induction, electrode placement and electric currents, with a number of criteria—- duration of seizure (or seizure threshold). degree of amnesia, total energy, are some clinical efficacy. Others have carefully documented that electrode placement alters clinical outcome little, but does reduce the degree of amnesia and alters the type of disorganization in neuropsychological tests. But the evidence for different effects for brief stimuli is still sparse. In Weaver's recent studies, he found that his LEBS delivered less joules to the 'head', but he could not demonstrate a difference either in clinical assessments or in degree or type of amnesia. In similar and . fashion, the present report also fails to define such differences. Yet, in a number of places, the implication is raised that brief stimulus treatment (MBCTA) is 'better'. For example, on page 1, you combine two thoughts in one sentence: "Two modifications of BCT technique; lateralized brain stimulation via unilateral electrode placement and the use of brief pulse stimuli have made it possible to diminish the severity of side-effects . . ." Again, on page 8: "No difference in suprathreshold seizure duration on the basis of stimulus waveform was found, suggesting that not only are the seizures with brief pulse stimuli produced by lower amount of electrical energy, but also that they are equivalent in terms of potency. . ." Now, the word 'potency' is not defined; I know you mean potency to deliver a seizure, but then, could it not mean potency in clinical terms ? This is compounded by the phrase (page 9, top) ". . and thereby possibly less therapeutically potent.9 I agree that a detailed test of the MECTA machine (or other brief stimulus) is needed, but the assessment should indicate the number of patients treated, the number of missed inductions, the number of seizure �Richard D. Weiner, M.D., Ph.D. ...... November 5, 1979 ......... page 2 seconds, changes in depression ratings, tests of neuropsychological functions, etc. Much of this has already been done for unilateral and bilateral electrode placements, and the evidence is quite compelling. Similar assessments need be done for brief stimuli, and until these are done cleanly, the equivalent efficacy of brief stimuli and safety in side— effects will remain open questions. Perhaps, such an assessment can be the basis of a collaborative and I would urge you to work with Dick Abrams to fermulate a useful protocol. I would hope that the issues (induction factors, assessment factors) will be defined carefully. effort, Again, My thanks for sharing these progress reports with for the delay in reading. my me, and my apologies regards. Sincerely yours, - . - u A. Fink, M.D. Professor of Psychiatry Max ~m-aw>r-w~.W;w--—m—.——W<Wmnwp that a bill regulating the consent procedures for psychosurgery and convulsive therapy is being prepared for the Assnmbly of the State of New York. I have read a preliminary draft, and it is clearly modelled upon the recent Califbrnia statutes. It is probable that the APA will be asked for its help by a committee in New York headed by Dr. Hurray P.S. W>w‘a\w"' .w wan—,v. w,.._..——wy v V w.» .v You should know Glusman of the New York State Psychiatric fitter from him or from the APA. Institute; and you may be hearing � 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 Correspondence 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 Correspondence to: Weiner, Richard D. 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