ELECTROCONVULSIVE THERAPY FOR YOUNG MINDS: A SOLUTION FOR MENTAL DYSFUNCTION OR A PROBLEM FOR COGNITION? A SYSTEMATIC REVIEW AND META-ANALYSIS

Abstract

Title: Electroconvulsive Therapy For Young Minds: A Solution For Mental Dysfunction Or A Problem For Cognition? A Systematic Review And Meta-Analysis

Introduction: Electroconvulsive therapy (ECT) is a medical treatment that involves brief electrical stimulation of the brain of patients, suffering from schizophrenia and severe major depression disorder, who otherwise would not respond to conventional treatments. The therapeutic effectiveness of ECT is well evident in current medical practice. However, adverse side effects, that include cognitive impairment, were reported following short and long-term exposure to ECT. The present study aims to address the question of whether ECT causes learning and memory deficits in the pediatric population, as the brain of children and adolescents is still undergoing development.

Methods: A systematic review and a meta-analysis were conducted to investigate the effect of ECT on memory functions, focusing on studies that used verbal learning test as an outcome in pediatric patients. Our search strategy, using Medline, Embase, Cochrane library, Web of science and Google scholar, yielded a total of 11 studies, which include 2 case reports, 2 case series, 7 cohort studies and no clinical trials. Criteria for inclusion were (1) Population of pediatric patients aged below 19 (2) Patients being subjected to ECT (3) Study comparator (before and after ECT (self-control) or patients not receiving ECT) and (4) Cognitive performance of patients being assessed objectively before and after ECT. The data were extracted directly from the selected articles and organized in standardized tables by one investigator and verified by a second. Publication bias was visually evaluated with a funnel plot, while the I Square Test assessed the heterogeneity of the studies, using Revman software.

Results and Conclusion: This is the first meta-analysis investigating the effects of ECT on cognitive outcomes in the pediatric population. Our data analysis revealed that cognitive functions in children and adolescents, assessed with the California Verbal Learning test, were not significantly impacted by ECT. While this procedure could have adverse effects on children on the short term, it is generally considered a safe procedure for pediatric cases, with no deleterious cognitive effects on the long term.