Factors Predicting Ictal Quality in Bilateral Electroconvulsive Therapy Sessions.

Aida De Arriba-Arnau,Antonia Dalmau Llitjos,Jordi Curto,Stelania Savino,Neus Salvat-Pujol,José Manuel Menchón,Virginia Soria,Mikel Urretavizcaya

doi:10.3390/brainsci11060781

Abstract

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.

Highlights

Electroconvulsive therapy (ECT) is a high-value treatment for psychiatric illnesses that provides great response rates [1,2,3] in a quick manner [4] and improves patient healthrelated quality of life [5].An effective acute electroconvulsive therapy (ECT) treatment course consists of multiple, usually 6 to 12, adequate sessions [6]
This study aimed to investigate which variables of the ECT session procedure impact the session’s seizure quality as measured by previously used scales of combined ictal EEG automated estimation parameters provided by the ECT device and manual ratings of postictal suppression (PSI)
The sample included 250 ECT sessions conducted in 47 patients

Summary

Introduction

Electroconvulsive therapy (ECT) is a high-value treatment for psychiatric illnesses that provides great response rates [1,2,3] in a quick manner [4] and improves patient healthrelated quality of life [5].An effective acute ECT treatment course consists of multiple, usually 6 to 12, adequate sessions [6]. It is known that seizure length increases when stimulus energy applied is too close to the seizure threshold, it is a low-quality seizure [14], and right unilateral ECT can produce seizures with poor therapeutic potency despite being of sufficient ictal duration if the dosage is not adequately suprathreshold [15,16]. There is a growing interest in finding seizure quality markers other than ictal duration [8,9] that can be evaluable in each ECT treatment session and that are tied to clinical improvements [17] to assure session adequacy, to guide clinicians’ decisions along the ECT course, and to optimize the sessions. Seizure characteristics related to the amplitude and shape of the ictal electroencephalogram (EEG) are used along with the duration [6]

Objectives

Methods

Discussion

Conclusion