Is electroconvulsive therapy an evidence-based treatment for catatonia? A systematic review and meta-analysis
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We aimed to review and discuss the evidence-based arguments for the efficacy of electroconvulsive therapy (ECT) in the treatment of catatonia. Randomized controlled trials (RCTs) and observational studies focusing on the response to ECT in catatonia were selected in PubMed, the Cochrane Library, Embase, ClinicalTrials.gov and Current Controlled Trials through October 2016 and qualitatively described. Trials assessing pre-post differences using a catatonia or clinical improvement rating scale were pooled together using a random effect model. Secondary outcomes were adverse effects of anesthesia and seizure. 564 patients from 28 studies were included. RCTs were of low quality and were heterogeneous; therefore, it was not possible to combine their efficacy results. An improvement of catatonic symptoms after ECT treatment was evidenced in ten studies (SMD = −3.14, 95% CI [−3.95; −2.34]). The adverse effects that were reported in seven studies included mental confusion, memory loss, headache, or adverse effects associated with anesthesia. ECT protocols were heterogeneous. The literature consistently describes improvement in catatonic symptoms after ECT. However, the published studies fail to demonstrate efficacy and effectiveness. It is now crucial to design and perform a quality RCT to robustly validate the use of ECT in catatonia.
Prospero registration information: PROSPERO 2016: CRD42016041660
KeywordsCatatonia Electroconvulsive therapy RCT Evidence-based medicine
The authors wish to thank Drs. Itziar Flamarique, Neeraj Gill, Kumar Girish, Sandeep Grover, Kotaro Hatta, Rakesh Karmacharya, Vivek Haridas Phutane, and Jagadisha Thirthalli for sharing their data and information about their respective studies.
Compliance with ethical standards
Conflict of interest
There are no conflicts of interest regarding this study. No authors received support from any company for the submitted work. AA, GV and PT have relationships (travel/accommodation expenses covered/reimbursed) with Otsuka, Lundbeck, Servier and Janssen. FN has relationships (travel/accommodation expenses covered/reimbursed) with Servier, BMS, Lundbeck, and Janssen, who might have an interest in the work submitted in the previous 3 years. No author’s spouse, partner, or children have any financial relationships that could be relevant to the submitted work. None of the authors has any non-financial interests that could be relevant to the submitted work.
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