MISSED SEIZURE DURING ELECTROCONVULSIVE THERAPY

Abstract

Background: Here, the authors reported two cases of electroconvulsive therapy with a missed seizure and present a literature review to explore the possible reasons and recommendations. To date, most authorities agreed seizure duration correlates to the effectiveness of the ECT, and a reason to a minimum of 25 seconds duration of seizure is defined as a good seizure. Many aspects of the seizures during the ECT are well researched and lots of data is available about the possible modifiers of seizures, indicators of an effective seizure, and ways to monitor an effective seizure but very few data reported missed seizures and strategies to follow in the events of no fits. In this case series, we described two cases of missed seizures which were identified and addressed appropriately with subsequent successful ECT sessions. We also presented the literature regarding the strategies to follow immediately post-event. Case 1: A 42-year-old married lady with a diagnosis of bipolar type I disorder, current episode manic, with psychotic symptoms (6A60.1) according to the ICD-11 diagnostic and classification system. Case 2: A middle-aged male with a diagnosis of severe depressive episodes with psychotic symptoms. Both cases had missed seizures during the 3rd session of the electroconvulsive therapy. Conclusion: Studies have shown that the phenomena of missed seizures are common but less reported and are caused by a number of factors including individual factors, the ECT technical parameters as well as concurrent use of pharmacological treatment and anesthetic agent which should be considered before every ECT session. There is a paucity of literature on the strategies to follow immediately after an event of no fits. Therefore, we tried to summarize some possible recommendations which need to be personalized according to a case-to-case basis.