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.

Recent Advances in Optimizing Electroconvulsive Therapy

2006 ◽  
Vol 40 (8) ◽  
pp. 632-638 ◽  
Author(s):  
Colleen K. Loo ◽  
Isaac Schweitzer ◽  
Chris Pratt
Keyword(s):  
Electrical Stimulation ◽  
Clinical Practice ◽  
Electroconvulsive Therapy ◽  
Case Reports ◽  
Seizure Threshold ◽  
Magnetic Seizure Therapy ◽  
Recent Advances ◽  
Future Clinical Practice ◽  
Alternative Means ◽  
Alternative Approaches

This review aims to summarize and critically evaluate the evidence for recent advances and alternative approaches in electroconvulsive therapy (ECT) technique. Novel developments in ECT research are also mentioned. An EMBASE literature search was undertaken of clinical trials, case reports and research updates on novel and alternative approaches in ECT practice and research, including alternative electrode placements, variations in stimulus configuration, and novel developments (magnetic seizure therapy, focal electrical stimulation). The evidence for these approaches is reviewed, and implications for the optimizing of ECT in clinical practice are discussed. Evidence from studies suggests that unilateral ECT be given at substantially suprathreshold doses (at least 6 times seizure threshold) for maximizing efficacy, while bilateral ECT is likely to be effective at doses of 1.5–2.5 times seizure threshold. There is some evidence to support the use of bifrontal ECT, although further research is required to establish its efficacy and side-effects relative to standard unilateral and bilateral electrode placements. Other alternative electrode placements have been minimally studied. More advantageous efficacy side-effect outcomes may be achieved by reducing the pulse width and/or frequency of the ECT stimulus. Lastly, novel developments using alternative means of seizure induction (magnetic fields, focal electrical stimulation) may hold promise for the future. Clinical practice should be guided by a careful appraisal of the available evidence for alternative approaches in ECT technique.

Right Unilateral Electroconvulsive Therapy at Six Times Seizure Threshold

2003 ◽  
Vol 37 (6) ◽  
pp. 715-719 ◽  
Author(s):  
John D. Little ◽  
Jo Munday ◽  
Gordon Lyall ◽  
Dennis Greene ◽  
Graeme Chubb ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Side Effects ◽  
Motor Activity ◽  
Electroconvulsive Therapy ◽  
Retrospective Review ◽  
Electrode Placement ◽  
Seizure Threshold ◽  
Eeg Activity ◽  
Cognitive Side Effects ◽  
Suppression Index

Objective: To examine the clinical practice of right unilateral electroconvulsive therapy (ECT) administered at six times seizure threshold (6 × RUL ECT). Method: A retrospective review of all patients who received 6 × RUL ECT between July 2000 and June 2002. Results: Twenty-one patients across a range of ages and diagnostic groups received D'Elia unilateral ECT at a seizure dosage at or above 388.8 milliCoumbs (mC). In order to sustain predetermined criteria for seizure adequacy, energy was increased in 71% of patients. Final seizure lengths of 45 s electroencephalographic (EEG) activity, 28 s motor activity (cuffed) and a post-ictal suppression index (PSI) of 83% were recorded. Eighty percent of patients responded after a mean of 7.0 treatments. Cognitive side-effects were noted in 21% of patients. Fifty-two percent relapsed on average 6.3 months after the last treatment despite continuation pharmacotherapy. Conclusions: 6 × RUL ECT was found to be clinically effective, associated with cognitive side-effects and relapse. The debate over electrode placement is likely to continue.

scholarly journals Audit of a recently introduced stimulus dosing policy in an electroconvulsive therapy clinic

1999 ◽  
Vol 23 (9) ◽  
pp. 541-543 ◽  
Author(s):  
G. Shaikh ◽  
R. Ireland ◽  
M. McBreen ◽  
R. Ramana
Keyword(s):  
Clinical Practice ◽  
Electroconvulsive Therapy ◽  
Initial Dose ◽  
Dose Adjustment ◽  
Seizure Threshold ◽  
Dose Titration ◽  
Clinical Implications ◽  
Threshold Estimation ◽  
And Training ◽  
Therapy Clinic

Aims and methodTo audit the clinical practice of seizure threshold estimation and subsequent stimulus dose adjustment in the electroconvulsive therapy (ECT) clinic. Case notes of patients who had ECT over a six-month period were audited. Results were discussed at an audit meeting and guidelines and training modified appropriately prior to the second cycle of the audit.ResultsInitial dose titration was poor in the first period, but improved in the second. The majority of patients were insufficiently stimulated after missed seizures in both periods and stimulus doses were not being reduced following prolonged seizures.Clinical implicationsThe audit identified the need for continuing supervision of trainees in addition to clear training and guidelines.

Electroconvulsive Therapy: Electric Stimulus Variables and the Convulsive Response

1991 ◽  
Vol 36 (9) ◽  
pp. 630-636 ◽  
Author(s):  
G.J. Bean ◽  
A.E. Rhodes ◽  
B.A. Martin
Keyword(s):  
Electroconvulsive Therapy ◽  
Electrical Energy ◽  
Electrical Stimulus ◽  
Routine Clinical Practice ◽  
Electrode Placement ◽  
Treatment Protocols ◽  
Electric Stimulus ◽  
Stimulus Waveform ◽  
Stimulus Energy ◽  
Grand Mal

The ability of an electrical stimulus to induce a grand mal convulsion during electroconvulsive therapy (ECT) was investigated using four clinical treatment protocols during which the stimulus waveform, the electrical energy and/or the electrode placement were varied. The statistically significant results support the view that a pulsatile square wave stimulus is effective in inducing convulsions, provided that the d'Elia and not the Muller unilateral electrode placement is used. Higher stimulus energy may be required for older patients. The results illustrate successive attempts to remedy a previously reported problem with the effectiveness of the pulsatile waveform as a convulsive stimulus. The benefit of maintaining a database of treatment variables in order to monitor the effect of changes in the protocol under conditions of routine clinical practice is also demonstrated.

Diagnosis and Management of Cardiomyopathies – A Focus on Genetics, Cardiac Magnetic Resonance and Clinical Features

2011 ◽  
Vol 7 (3) ◽  
pp. 225
Author(s):  
Gianfranco Sinagra ◽  
Michele Moretti ◽  
Giancarlo Vitrella ◽  
Marco Merlo ◽  
Rossana Bussani ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Cardiac Magnetic Resonance ◽  
Magnetic Resonance ◽  
Imaging Techniques ◽  
Molecular Genetic ◽  
Molecular Genetic Analysis ◽  
Routine Clinical Practice ◽  
Clinical Approach ◽  
Diagnosis And Management ◽  
Made In

In recent years, outstanding progress has been made in the diagnosis and treatment of cardiomyopathies. Genetics is emerging as a primary point in the diagnosis and management of these diseases. However, molecular genetic analyses are not yet included in routine clinical practice, mainly because of their elevated costs and execution time. A patient-based and patient-oriented clinical approach, coupled with new imaging techniques such as cardiac magnetic resonance, can be of great help in selecting patients for molecular genetic analysis and is crucial for a better characterisation of these diseases. This article will specifically address clinical, magnetic resonance and genetic aspects of the diagnosis and management of cardiomyopathies.

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