Seizure Quality Research Articles

Anesthesia for electroconvulsive therapy.

Anesthesia for electroconvulsive therapy.

The development and retrospective testing of an electroencephalographic seizure quality-based stimulus dosing paradigm with ECT.

The optimization of electroconvulsive therapy (ECT) stimulus dosing remains uncertain. Previous work suggests the potential utility of ictal EEG models of seizure adequacy, but such models have never been tested for their ability to improve the clinical dosing of ECT treatments. Using data from 149 depressed patients, the authors developed an ictal electroencephalographic (EEG) model that can discriminate seizures produced by more therapeutically effective and less efficacious types of stimuli. They retrospectively determined how stimulus dosing according to this seizure adequacy-based model would have differed from that actually used in an additional 61 patients who received ECT according to a standard clinical dose-titration and EEG seizure duration-based dosing strategy. Although the model indicated an increase in stimulus intensity at some point during the ECT treatment course in 23 of 61 patients, only 5 of these 23 actually received a clinical increase in stimulus intensity. The patients who did not receive this increase had a significantly diminished therapeutic response compared with the other patients. Conversely, the model also indicated that an increase in stimulus intensity that occurred clinically might have been unnecessary to achieve therapeutic efficacy in 11% of the patients. This study provides preliminary evidence that ictal EEG models have the potential to make clinically relevant seizure adequacy distinctions among ECT treatments. Further prospective work is indicated to determine the clinical utility of such models.

Physiological response to ECT stimulus dose

For a physiological effect to be useful to regulate the electrical stimulus dose used in electroconvulsive therapy (ECT), it must show sensitivity to the stimulus dose. In the analogy of using blood drug concentration to regulate drug dosage, this concentration must be sensitive to the dose. Accordingly, we examined the sensitivity of several physiological effects to ECT stimulus dose. Previously no substantial sensitivity of physiological effects was found when generally effective ECT methods were used. EEG post-ictal suppression, recruitment phase duration, wave form regularity and spike-and-wave frequencies, peak seizure heart rate (HR), and several types of seizure duration were measured with standard and higher dose stimuli given on separate days to 24 subjects. Left frontal to right temporal asymmetric bilateral stimulus placement was applied. Peak HR ( P=0.007, t=2.7) and EEG recruitment phase duration ( P=0.04, t=1.9) varied with stimulus dose, by 12 beats/min and 1.3 s, respectively. Only peak HR ( P=0.02, t=2.2) varied with stimulus dose (by 6 beats/min) when subjects who showed only EEG seizure but no motor seizures were excluded. Subjects who maintained peak HR near their individual maximum values received fewer ECTs than other subjects ( P=0.00003, t=5.20); this greater efficacy suggests that the peak HR reflects clinical efficacy as well as stimulus dose. In addition to EEG measurements, peak HR is a candidate to measure ECT seizure quality and provide feedback for stimulus dose regulation.

A Comparison of Visual and Computer-Generated Measures of ???Seizure Quality???

We report on the first direct comparison of measures of seizure quality generated by visual rating of electroencephalographic (EEG) regularity and postictal suppression with THYMATRON-DGx computer-generated indices of seizure energy and postictal suppression. Thirty-two consecutive patients referred for electroconvulsive therapy (166 consecutive treatments) were studied. Blinded ratings of seizure duration, regularity, and postictal EEG amplitude suppression derived from the paper EEG were compared against computer-rated measures of seizure duration, seizure energy index, mean ictal amplitude, and postictal suppression. Our results confirm previous findings of high correlations between computer and visual determinations of seizure duration. Significant differences were found for computer-derived postictal suppression, seizure energy index and mean ictal amplitude for different levels of the visual rating scales. Our results provide preliminary support for the concurrent validity of these measures.

ECT Stimulus Parameters as Determinants of Seizure Quality

ECT Stimulus Parameters as Determinants of Seizure Quality

Propofol and methohexital as anaesthetics in electroconvulsive therapy (ECT): A comparison of seizure parameters, seizure quality features and vital signs

Propofol and methohexital as anaesthetics in electroconvulsive therapy (ECT): A comparison of seizure parameters, seizure quality features and vital signs