Pocatello gets ECT

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POCATELLO - Dr. Predrag Gligorovic flashed a grin reminiscent of a child with a long-awaited new toy as he screwed a pair of electrodes into the high-tech machine he'd received earlier that day.

It was a metal box not much bigger than a VCR, but the Portneuf Medical Center psychiatrist is sure it will change lives dramatically for local mental health patients with no other options left.

''I'm so happy about this!'' the brawny, 6-foot, 4-inch doctor said in a gleeful Serbian accent as he peered up from his machine. ''This is the latest of the latest - all the bells and whistles.''

On July 9, PMC's Behavioral Health Services program will bring back electroconvulsive therapy in Southeast Idaho.

It's a technology that still hasn't shaken a stigma dating back to the 1950s, before anesthetics were available for patients. In those days, ECT, as it's called, was a treatment of first resort because medical science offered no effective alternatives.

Though most psychiatrists agree with Gligorovic that the first treatment discovered is still the best, no one fully understands why ECT works. It's useful in treating mental ailments that include schizophrenia, bipolar disorder and debilitating depression.

''The best understanding is it works on protein receptors in the brain which are responsible for transmission of impulses through hormones in our brain,'' explained Gligorovic, chief of psychiatry services at PMC. ''It's really amazing that somebody invented that 70 years ago, and we still don't know what is happening now.''

The principle behind ECT was first published by Ladislas Meduna in 1935. The doctor noticed people who were prone to seizures had more brain tissue. By contrast, schizophrenics had less brain tissue.

So Meduna figured that inducing seizures by giving patients a medication called metrazol he could effectively treat schizophrenia. The treatment became known as shock therapy because it sent the body into shock.

Electricity entered the equation when Italian neuropsychiatrist Ugo Cerletti built upon Meduna's findings and started using electroshock to induce the seizures.

Gligorovic believes ECT has been cast aside due to a combination of misinformation about the procedure, a prevailing belief that pharmaceutical companies would deliver a ''magic pill,'' time constraints and especially the cost of administering it.

''It's considered to be a treatment of last resort but that's because it's more expensive, it's more time-consuming and it's more complicated and insurance companies push you to medication more times than not,'' Gligorovic said.

Gligorovic attended Columbia University in New York to obtain his additional certification in ECT and recommended that PMC bring back the treatment when he joined the medical staff about two years ago.

ECT today is a far cry from the 1950s, when patients endured seizures without the benefit of anesthetics to relax their muscles. The most dangerous part of ECT is the application of anesthetics, and modern technology that has reduced the length of the shock has lessened the side effects, which include short-term memory loss and disorientation.

At PMC, ECT treatments will be done in an operating room with anesthesiologists and nursing staff present.

Obtaining time in an operating room, where competing procedures bring in considerably more money for hospitals, has been one of the major obstacles facing ECT.

''For us, that was a big challenge,'' Gligorovic said. ''But PMC was willing to accommodate the operation room schedule and anesthesiologist's time to fulfill a need of the community. This is a treatment that's helping so many people, and it really should be available.''

Administering ECT

Electric shocks will last between 0.25 and 3 seconds at the new PMC program, and seizures will persist for between 30 and 90 seconds.

The hospital already has a list of about four patients interested in ECT, and Gligorovic plans to treat about six patients each day he performs it. ECT will be offered on Mondays, Wednesdays and Fridays.

''Usually, patients show significant clinical improvements after six to eight treatments. After three times, there's a big difference. After two weeks, you're way, way better,'' Gligorovic said.

Given the strides made in ECT technology, Gligorovic said it's now possible for people to have the procedure on an out-patient basis, provided that they have a family member available to take them home and observe them.

In addition to confusion, most patients experience memory loss for the half hour preceding ECT and the hour afterward.

Gligorovic has approached Idaho State University's school of psychology to see if students would be interested in researching memory loss and memory preservation among the ECT patients at PMC.

The treatment is particularly beneficial for patients who have been resistant to medication, senior citizens who have bad side effects from antidepressants and pregnant women who worry medication could interfere with child development.

Gligorovic estimates half of ECT patients do well after a single set of treatments. Another 25 percent must come back routinely, perhaps every month, for ''maintenance'' treatments. And then there are patients who must continue taking medication in addition to their ECT treatments, although Gligorovic believes most of them ''do much better than before.''

While under anesthesia, an electroencephalogram will measure patients' brain waves, and the only physical indication of the seizure will be twitching of the hand or big toe.

Gligorovic recommends pairing ECT with psychotherapy.

''Having therapy will make new circuitry. Psychotherapy is very appropriate and very encouraged to be done with ECT,'' he said.

The PMC program will require recommendations from two psychiatrists that ECT is appropriate. Gligorovic, Dr. Bill Hazle, also a PMC psychiatrist, and Dr. John Reichman, of Pocatello, will most likely collaborate to provide those recommendations.

By John O'Connell

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