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THE ELECTROSHOCK CONVULSION SYNDROME
PAUL H. WILCOX
Am J Psychiatry 1944;100:668-673.
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Traverse City State Hospital, Traverse City, Mich.

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Abstract

The evidence that the electroshock convulsion syndrome is the result of integrated activity of a cortical area near the fissure of Rolando and is essentially a pyramidal tract syndrome can be summarized as follows:1. Electrical shocks given near the fissure of Rolando are the most efficient in producing convulsions.2. The tonic pattern looks like the result of generalized excitation of the motor cortex.3. Pyramidal tract impairment modifies the convulsive pattern.4. Extrapyramidal tract disease does not modify the convulsive pattern.5. Autonomic excitation appears to be a secondary phenomenon.6. No simple medullary syndrome occurs. The medulla seems to be responding differentially to stimulation from above.7. The "trigger zone" of the electroshock convulsion syndrome responds to various strengths and durations of iterative stimuli with summation to the threshold convulsive dose typical of a strength-duration curve.8. Anticonvulsant drugs such as sodium amytal act primarily on the higher cortical levels of integration. They also increase the convulsive threshold. Therefore, the "trigger" zone is probably at a fairly high level of cortical integration.It is further suggested that the "trigger zone" plays a central role in all convulsions, epilepsy arising when there is an overflow of excess excitation from some other area to the "trigger zone" of the convulsive syndrome. The complex character of the convulsive patterns in epilepsy may result from the modifying influence of the cerebral dysrhythmias. Loss of consciousness may be due to interference with the normal integrative balance of the cortex, rather than due to the "knocking out" of any centers.

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