This video demonstrates how to assess motor dysfunction in people with a history of repeated low-voltage electrical injury using the Box and Block test, a typical occupational therapy assessment with normative values against which to compare results.
- Test Details
- Noteworthy Initial Observations
- Acquired Channelopathies from ECT
- Assessment Types & Methods Matter in ECT Injury Diagnosis
- Test duration & Worsening Symptoms
- Patient History
- 10 Year Delay in Assessment
- General Motor Dysfunction Listed as Serious ECT Adverse Event
- Patient Diagnosis
- ECT Given to Patient Based on Misdiagnosis
- Electroporation Amplifies Drug Toxicity
- Further Reading
Noteworthy Initial Observations
Note how initially the patient seems very capable of completing a simple task, but repeating the task stresses the body’s ability to transmit electrolytes across the nervous system.
Acquired Channelopathies from ECT
This is called acquired channelopathies which can be caused by repeated exposure to pulsed high electric fields.
Assessment Types & Methods Matter in ECT Injury Diagnosis
This video highlights the importance of modifying differential assessments of coordination, balance, reflexes, sensation, cranial nerves and autonomic nervous system function for patients who have a history of exposure to pulsed, high electric fields.
Conducting a functional test once (i.e touching finger to nose to finger) will not capture dysfunction which only arises when repeating a function at least 20 times. However repeating a functional test at least 20 times will amplify the problem (ie. touch touching finger to nose to finger 20 times).
Watch closely for subtle changes in function between the patient’s ability at the beginning of the test compared to their ability at the end of the test.
Test duration & Worsening Symptoms
The longer the test is repeated the more pronounced the dysfunction will become–especially as the person ages/becomes further removed from electric field exposure.
In this case study, the patient has a history of chronic electroconvulsive therapy (116 treatments) on an device which pulses out 900mA for up to eight seconds, 450 volts and 504 mC.
10 Year Delay in Assessment
Treatment took place more than 10 years before this video was recorded. It took more than a decade to gain access to appropriate comprehensive assessments for progressive motor dysfunction.
General Motor Dysfunction Listed as Serious ECT Adverse Event
This video documents a how to quantify “general motor dysfunction,” a serious adverse event listed in the 2019 Thymatron Electroconvulsive Therapy device “Instructions for Use” user manual.
The device has no premarket approval safety testing or electrical dosing limits on record with medical device regulators.
The patient is diagnosed with Neurological Sequelae of Low-voltage electrical injury; Myoneural Disease, Unspecified.
In carefully tracking symptom manifestation and triggers at home, this patient also has clinical manifestations of acquired channelopathies which cause periodic paralysis, episodic dystonia, episodic ataxia, episodic verbal apraxia of speech, dyspraxia and acquired sensory integration and acquired sensory processing disorder secondary to repetitive mild and moderate intracranial Traumatic Brain Injury.
ECT Given to Patient Based on Misdiagnosis
Patient received ECT because she was initially diagnosed and treated for treatment resistant schizoaffective disorder bipolar type with agitated catatonia and psychosis–which were actually psychiatric symptoms due to a now known physiological cause: hepatic encephalopathy (fungal) and toxic metabolic encephalopathy (hyperammonemia from psychiatric medications).
Electroporation Amplifies Drug Toxicity
Pulsed high electric fields open pores in cell membranes (electroporation) amplifying drug and toxicity effects.
Can ECT cause Brain damage? Yes.
To better understand microstructural damages caused by ECT, please see Does Electroconvulsive Therapy (ECT) cause permanent microstructural brain damage?
To help people with a history of ECT’s functional brain injury gain access to appropriate comprehensive assessments please sign our patient safety petition.