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Reconsidering the seizure threshold? A retrospective study about seizure quality among patients with maintenance ECT

Published online by Cambridge University Press:  06 November 2018

Simon Taib ,
Anna Levy ,
Christophe Arbus ,
Laurent Schmitt  and
Antoine Yrondi
Simon Taib*
Affiliation:
Centre Hospitalier Universitaire de Toulouse, Service universitaire de psychiatrie et psychologie médicale, Toulouse, France INSERM UMR 1214, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
Anna Levy
Affiliation:
Centre Hospitalier Universitaire de Toulouse, Service universitaire de psychiatrie et psychologie médicale, Toulouse, France
Christophe Arbus
Affiliation:
Centre Hospitalier Universitaire de Toulouse, Service universitaire de psychiatrie et psychologie médicale, Toulouse, France INSERM UMR 1214, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
Laurent Schmitt
Affiliation:
Centre Hospitalier Universitaire de Toulouse, Service universitaire de psychiatrie et psychologie médicale, Toulouse, France
Antoine Yrondi
Affiliation:
Centre Hospitalier Universitaire de Toulouse, Service universitaire de psychiatrie et psychologie médicale, Toulouse, France INSERM UMR 1214, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
*
Author for correspondence: Simon Taib, Centre Hospitalier Universitaire de Toulouse, Service universitaire de psychiatrie et psychologie médicale, Toulouse 31059, France. Tel: 05 34 55 75 23; Fax: 05 34 55 75 21; E-mail: [email protected]
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Abstract

Objectives

Electroconvulsive therapy (ECT) is a safe and validated technique used to treat various psychiatric conditions. It triggers an artificially-induced seizure. This seizure is defined using several parameters such as the amount of energy, duration, frequency, pulse width and intensity. Efficacy and adverse events depend on the amount of energy delivered. Due to technical control, the amount of energy delivered by our unit’s ECT device was limited to 614 mC, 60% of the maximum possible output of the device. We wondered if lowering the dose would lead to better seizure quality among maintenance ECT patients.

Methods

We assessed seizure quality based on the EEG, using a validated tool created by MacPherson. Two evaluators independently rated the seizures. Pre- and post-control scores were compared using Student’s t-test for paired samples.

Results

We analysed data from 15 patients. Mean age was 65 years old. Twelve had depressive disorder, two had schizophrenia and one had schizo-affective disorder. Mean duration of seizure before control was 41.1 s [95% confidence interval (95CI)=26.1, 51.1]. The mean MacPherson’s score was 20.3 (95CI=16.2, 24.4). After control, the mean MacPherson’s score was 28.2 (23.1, 33.3), showing a significant difference with the pre-control dataset (p=0.032; t=−2.4; df=14). Specifically, peak mid-ictal amplitude increased from 6.9 (95CI=5.1, 8.7) to 10.0 (95CI=7.2, 12.8). Other sub-scores remained unchanged.

Conclusion

Lowering the energy delivered led to an overall increase of seizure quality among our sample. This highlights the necessity and utility of retitration during ECT maintenance, possibly leading to better management of our patients.

Keywords

EEGelectroconsulsive therapymajor depressive disorder, seizure
Type
Short Communication
Information
Acta Neuropsychiatrica , Volume 31 , Issue 1 , February 2019 , pp. 52 - 55
Copyright
© Scandinavian College of Neuropsychopharmacology 2018 

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References

1. American Psychiatric Association (2008) The practice of electroconvulsive therapy: recommendations for treatment, training, and privileging (a task force report of the American Psychiatric Association). Arlington, VA: American Psychiatric Association.Google Scholar
2. UK ECT Review Group (2003) Efficacy and safety of electroconvulsive therapy in depressive disorders: a systematic review and meta-analysis. Lancet Lond Engl 361, 799–808.Google Scholar
3. Andrade, C, Arumugham, SS Thirthalli, J (2016) Adverse effects of electroconvulsive therapy. Psychiatr Clin North Am 39, 513–530.Google Scholar
4. Peterchev, AV, Rosa, MA, Deng, Z-D, Prudic, J Lisanby, SH (2010) Electroconvulsive therapy stimulus parameters: rethinking dosage. J ECT 26, 159–174.Google Scholar
5. Sackeim, HA, Prudic, J, Nobler, MS, Fitzsimons, L, Lisanby, SH, Payne, N, Berman, RM, Brakemeier, EL, Pereta, T Devenand, DP (2008) Effects of pulse width and electrode placement on the efficacy and cognitive effects of electroconvulsive therapy. Brain Stimul 1, 71–83.Google Scholar
6. Elias, A, Phutane, VH, Clarke, S Prudic, J (2018) Electroconvulsive therapy in the continuation and maintenance treatment of depression: systematic review and meta-analyses. Aust N Z J Psychiatry 52, 415–424.Google Scholar
7. Rasmussen, K (2002) The practice of electroconvulsive therapy: recommendations for treatment, training, and privileging (second edition). J ECT 18, 58–59.Google Scholar
8. Petrides, G Fink, M (1996) The ‘half-age’ stimulation strategy for ECT dosing. Convuls Ther 12, 138–146.Google Scholar
9. Fink, M, Petrides, G, Kellner, C, Mueller, M, Knapp, R, Husain, MM, Rasmussen, K, Rummans, T, O'connor, K the CORE Group, (2008) Change in seizure threshold during electroconvulsive therapy. J ECT 24, 114–116.Google Scholar
10. Wild, B, Eschweiler, GW Bartels, M (2004) Electroconvulsive therapy dosage in continuation/maintenance electroconvulsive therapy: when is a new threshold titration necessary? J ECT 20, 200–203.Google Scholar
11. Minelli, A, Abate, M, Zampieri, E, Gainelli, G, Trabucchi, L, Segala, M, Sartori, R, Gennarelli, M, Conca, A Bortolomasi, M (2016) Seizure adequacy markers and the prediction of electroconvulsive therapy response. J ECT 32, 88–92.Google Scholar
12. MacPherson, RD, Lawford, J, Simpson, B, Mahon, M, Scott, D Loo, C (2010) Low dose lignocaine added to propofol does not attenuate the response to electroconvulsive therapy. J Affect Disord 126, 330–333.Google Scholar
13. Micoulaud-Franchi, JA, Quilès, C, Cermolacce, M, Belzeaux, R, Adida, M, Fakra, E Azorin, JM (2016) Electroconvulsive therapy and level of evidence: from causality to dose–effect relationship. L’Encephale 42, S51–S59.Google Scholar
14. Sackeim, HA, Prudic, J, Devanand, DP, Kiersky, JE, Fitzsimons, L, Moody, BJ, McElhiney, MC, Coleman, EA Settembrino, JM (1993) Effects of stimulus intensity and electrode placement on the efficacy and cognitive effects of electroconvulsive therapy. N Engl J Med 328, 839–846.Google Scholar
15. McCall, WV, Reboussin, DM, Weiner, RD Sackeim, HA (2000) Titrated moderately suprathreshold vs fixed high-dose right unilateral electroconvulsive therapy: acute antidepressant and cognitive effects. Arch Gen Psychiatry 57, 438–444.Google Scholar