Changes in Seizure Threshold Over the Course of Electroconvulsive Therapy Affect Therapeutic Response and Are Detected by Ictal EEG Ratings

1998 ◽  
Vol 10 (2) ◽  
pp. 178-186 ◽  
Author(s):  
Andrew D. Krystal ◽  
C. Edward Coffey ◽  
Richard D. Weiner ◽  
Tracey Holsinger
Keyword(s):  
Electroconvulsive Therapy ◽  
Therapeutic Response ◽  
Seizure Threshold ◽  
Ictal Eeg

scholarly journals Factors Predicting Ictal Quality in Bilateral Electroconvulsive Therapy Sessions

2021 ◽  
Vol 11 (6) ◽  
pp. 781
Author(s):  
Aida de Arriba-Arnau ◽  
Antonia Dalmau Llitjos ◽  
Virginia Soria ◽  
Stelania Savino ◽  
Neus Salvat-Pujol ◽  
...  
Keyword(s):  
Oxygen Saturation ◽  
Electroconvulsive Therapy ◽  
Seizure Threshold ◽  
Ictal Eeg ◽  
Seizure Quality ◽  
Benzodiazepine Use ◽  
Postictal Suppression ◽  
The Impact ◽  
Therapy Sessions ◽  
Predict Treatment Response

In electroconvulsive therapy (ECT), ictal characteristics predict treatment response and can be modified by changes in seizure threshold and in the ECT technique. We aimed to study the impact of ECT procedure-related variables that interact during each session and might influence the seizure results. Two hundred and fifty sessions of bilateral ECT in forty-seven subjects were included. Seizure results were evaluated by two different scales of combined ictal EEG parameters (seizure quality index (SQI) and seizure adequacy markers sum (SAMS) scores) and postictal suppression rating. Repeated measurement regression analyses were performed to identify predictors of each session’s three outcome variables. Univariate models identified age, physical status, hyperventilation, basal oxygen saturation, days between sessions, benzodiazepines, lithium, and tricyclic antidepressants as predictors of seizure quality. Days elapsed between sessions, higher oxygen saturation and protocolized hyperventilation application were significant predictors of better seizure quality in both scales used in multivariate models. Additionally, lower ASA classification influenced SQI scores as well as benzodiazepine use and lithium daily doses were predictors of SAMS scores. Higher muscle relaxant doses and lower applied stimulus intensities significantly influenced the postictal suppression rating. The study found several modifiable procedural factors that impacted the obtained seizure characteristics; they could be adjusted to optimize ECT session results.

Electroconvulsive Therapy and the Seizure Threshold*

1983 ◽  
Vol 28 (6) ◽  
pp. 445-448 ◽  
Author(s):  
B.A. Martin ◽  
S. Strigler ◽  
K. Bezchlibnyk ◽  
G.E. Harris-Brandts
Keyword(s):  
Clinical Practice ◽  
Electroconvulsive Therapy ◽  
Electrical Energy ◽  
Sine Wave ◽  
Routine Clinical Practice ◽  
Large Series ◽  
Seizure Threshold ◽  
Square Wave ◽  
Rate Of Failure

The use of a pulsatile square wave stimulus for a large series of electroconvulsive treatments under conditions of routine clinical practice is compared to the equivalent experience with a sine wave stimulus. The literature indicates that both waveforms are equally effective convulsants. However, in this series, the induction of a convulsion was found to be much more difficult with the pulsatile square wave such that the rate of failure to convulse was four times that compared to sine wave stimulation. A number of variables that may affect the seizure threshold during ECT were examined. It is concluded that the benefit obtained by reducing the electrical energy transmitted to the patient with the pulsatile stimulus offsets the difficulty encountered in reaching the seizure threshold.

scholarly journals Induction agents in electroconvulsive therapy: a comparison of methohexitone and propofol

2002 ◽  
Vol 26 (12) ◽  
pp. 455-457 ◽  
Author(s):  
Allan Scott ◽  
Harold Boddy
Keyword(s):  
Electroconvulsive Therapy ◽  
Therapeutic Efficacy ◽  
Seizure Threshold ◽  
Clinical Implications ◽  
Seizure Duration ◽  
Efficacy Of Treatment ◽  
Induction Agents ◽  
Subject Comparison

Aims and MethodTo compare methohexitone and propofol in electroconvulsive therapy (ECT). A retrospective within-subject comparison was made of the use of these drugs in separate courses of bilateral ECT in one clinic over 10 years. Patients taking mood stabilising or anti-epileptic drugs were excluded. The initial seizure threshold and seizure duration were of particular interest.ResultsThe median initial seizure thresholds were identical (75 mC). The median initial seizure duration with threshold stimulation was 25% shorter with propofol (21v.28 s). The median total numbers of treatments in the courses were identical (eight treatments).Clinical ImplicationsThe shorter seizure duration observed with propofol was not associated with a commensurate rise in the initial seizure threshold. The shorter seizure duration may therefore have no effect on the therapeutic efficacy of treatment.

scholarly journals Alfentanil anesthetic augmentation lengthens seizure duration in electroconvulsive therapy with older people

2016 ◽  
Vol 28 (6) ◽  
pp. 1051-1052
Author(s):  
Craig D'Cunha ◽  
Christos Plakiotis ◽  
Daniel W. O'Connor
Keyword(s):  
Side Effects ◽  
Older People ◽  
Electroconvulsive Therapy ◽  
Electrode Placement ◽  
Seizure Threshold ◽  
Dose Titration ◽  
Seizure Duration ◽  
New Learning ◽  
Prescription Rates ◽  
Cognitive Side Effects

Electroconvulsive therapy (ECT) prescription rates rise with age, making it important that treatments be made as effective and safe as possible (Plakiotis et al., 2012). Older people are vulnerable to post-treatment confusion and to subsequent deficits in attention, new learning, and autobiographical memory (Gardner and O'Connor, 2008). Strategies to minimize cognitive side-effects include unilateral electrode placement and stimulus dose titration whereby electrical charge is individually calibrated to seizure threshold (Sackeim et al., 2000). It remains the case, however, that threshold levels typically rise over the treatment course, leading to an increase both in delivered charge and the risk of adverse sequelae.

scholarly journals Recovery after ECT: comparison of propofol, etomidate and thiopental

2008 ◽  
Vol 30 (2) ◽  
pp. 149-151 ◽  
Author(s):  
Moacyr A Rosa ◽  
Marina O Rosa ◽  
Iara M T Belegarde ◽  
Celso R Bueno ◽  
Felipe Fregni
Keyword(s):  
Electroconvulsive Therapy ◽  
Electric Charge ◽  
Seizure Threshold ◽  
Recovery Profile ◽  
Different Types ◽  
The Mean ◽  
Hypnotic Drugs ◽  
To Receive ◽  
Mean Time ◽  
Therapy Treatment

OBJECTIVES: To compare post anesthetic time for patient recovery after electroconvulsive therapy, as measured by the post anesthetic Recovery Score of Aldrete and Kroulik, using three different types of hypnotic drugs (propofol, etomidate and thiopental). METHOD: Thirty patients were randomized to receive one of the three drugs (n = 10 in each group), during a course of electroconvulsive therapy treatment. Patients and raters were blinded to which drug was received. Main treatment characteristics were recorded (as total electric charge received seizure threshold, number of treatments, and the mean time for recovery) along the whole treatment. RESULTS: Thiopental and propofol were associated with a significance increase in charge needed to induce a seizure (p < 0.0001) when compared to etomidate, as well as a significant decrease of time for recovery (p = 0.042). CONCLUSIONS: These findings suggest that, although there seems to be no difference in the clinical outcome across these three drugs, propofol offers the best recovery profile. However, it makes a higher mean electric charge necessary.

scholarly journals Blood plasma B vitamins in depression and the therapeutic response to electroconvulsive therapy

2020 ◽  
Vol 4 ◽  
pp. 100063
Author(s):  
Karen M. Ryan ◽  
Kelly A. Allers ◽  
Andrew Harkin ◽  
Declan M. McLoughlin
Keyword(s):  
Blood Plasma ◽  
Electroconvulsive Therapy ◽  
Therapeutic Response ◽  
B Vitamins

Which Depressed Patients will Respond to Electroconvulsive Therapy?

1989 ◽  
Vol 154 (1) ◽  
pp. 8-17 ◽  
Author(s):  
Allan I. F. Scott
Keyword(s):  
Effective Treatment ◽  
Clinical Features ◽  
Electroconvulsive Therapy ◽  
Physiological Responses ◽  
Depressive Illness ◽  
Seizure Threshold ◽  
Posterior Pituitary ◽  
Clinical Predictors ◽  
Depressed Patients ◽  
Wide Range

A small yet significant minority of contemporary patients with endogenous depressive illness who are treated with electroconvulsive therapy (ECT) gain little or no benefit. It is argued that the use of clinical features alone may not improve the ability to predict outcome after ECT. Many biological measures have been used to attempt to identify depressed patients for whom ECT would be an effective treatment, but none has yet been shown to be superior to clinical predictors. Depressed patients show a wide range of physiological responses to the first treatment of a course of ECT. Of these physiological responses, estimations of seizure threshold and of the release of posterior pituitary peptides merit further investigation as putative predictors of recovery.

Seizure Threshold Determination for Electroconvulsive Therapy: Stimulus dose Titration Versus Age-Based Estimations

2006 ◽  
Vol 40 (2) ◽  
pp. 188-192 ◽  
Author(s):  
John W.G. Tiller ◽  
Nicholas Ingram
Keyword(s):  
Major Depressive Disorder ◽  
Electroconvulsive Therapy ◽  
Significant Positive Correlation ◽  
Psychiatric Patients ◽  
Seizure Threshold ◽  
Dose Titration ◽  
High Dose ◽  
Major Depressive ◽  
Males And Females ◽  
Age Determinations

Objective: This study compared electroconvulsive therapy (ECT) seizure threshold determined by stimulus dose titration with age-based estimations. Method: Patients with major depressive disorder had their initial seizure thresholds determined by stimulus dose titration and the results compared with age-based estimations. There are no significant differences in thresholds determined by these methods. Results: Two hundred and three psychiatric patients (149 females, 54 males) had their seizure thresholds determined by stimulus dose titration. There was a significant positive correlation between seizure thresholds and age for males and females with male thresholds greater than female thresholds. Age determinations of seizure threshold would have resulted in excessive initial treatment stimuli for 30% of females and 8% of males. Ineffective stimulus doses would have been given to 2% of females and 7% of males on a full age basis and 64% using a half age strategy. Conclusions: For effective high-dose right unilateral ECT, initial seizure threshold should be determined by stimulus dose titration.

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