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Motor seizure monitoring during electroconvulsive therapy

Published online by Cambridge University Press:  02 January 2018

Prashanth M. Mayur ,
B. N. Gangadhar ,
N. Janakiramaiah  and
D. K. Subbakrishna
Prashanth M. Mayur
Affiliation:
Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, India
B. N. Gangadhar*
Affiliation:
Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, India
N. Janakiramaiah
Affiliation:
Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, India
D. K. Subbakrishna
Affiliation:
Department of Biostatistics, National Institute of Mental Health and Neurosciences, Bangalore, India
*
Dr B. N. Gangadhar, Additional Professor, Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, 560029, India. Fax: 0091-80-6631830; e-mail: [email protected]
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Abstract

Background

The occurrence of a seizure during electroconvulsive therapy (ECT) should be confirmed. Most clinicians use motor seizure monitoring alone and recent guidelines have not considered electroencephalogram (EEG) monitoring mandatory.

Aims

To examine the potential pitfalls of motor seizure monitoring.

Method

Consenting consecutive patients (n=232) were prospectively studied at the first ECT session using both motor and EEG seizure monitoring. It was ensured (by titration) that all the patients had an adequate EEG seizure. Adequate and prolonged seizures were defined according to the latest recommendations of the Royal College of Psychiatrists.

Results

Motor seizure was inadequate in 15 (7%) of patients. EEG seizure was prolonged in 38 (16%) of patients. Fifteen patients (39%) did not have a prolonged motor seizure. Motor seizure correlated well (r=0.8, P < 0.001) with EEG seizure when the latter was adequate, but not when prolonged (r=0.12, P > 0.5).

Conclusions

Motor seizure monitoring without EEG is undependable. The study provides a rational basis for the Royal College of Psychiatrists' definition of prolonged EEG seizure.

Type
Papers
Information
The British Journal of Psychiatry , Volume 174 , Issue 3 , March 1999 , pp. 270 - 272
Copyright
Copyright © 1999 The Royal College of Psychiatrists 

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Footnotes

Declaration of interest

Research grants were received from Karnataka State Council for Science and Technology 1997–1998.

References

Abrams, R. (1997) Electroconvulsive Therapy. New York: Oxford University Press.Google Scholar
American Psychiatric Association (1990) The practice of ECT: recommendations for treatment, training and privileging. Convulsive Therapy, 6, 85–120.Google Scholar
Christensen, P. & Koldbaek, I. (1982) EEG monitored ECT. British Journal of Psychiatry, 141, 19–23.Google Scholar
Fink, M. (1987) New technology in convulsive therapy: a challenge in training. American Journal of Psychiatry, 144, 1195–1198.Google Scholar
Gangadhar, B. N., Candade, V. S., Laxmanna, G., et al (1995) Computers in ECT and paperless monitoring. Indian Journal of Psychiatry, 37, 98.Google ScholarPubMed
Gangadhar, B. N., Girish, K., Janakiramaiah, N., et al (1998) Formula method for stimulus setting in bilateral ECT: a validation study. Journal of ECT, in press.Google Scholar
Greenberg, L. B. (1985) Detection of prolonged seizure during electroconvulsive therapy: A comparison of electroencephalogram and cuff monitoring. Convulsive Therapy, 1, 32–37.Google Scholar
Guy, W. (1976) ECDEU Assessment Manual for Psychopharmacology. Revised DHEW Pub. (ADM). Rockville, MD: National Institute for Mental Health.Google Scholar
Jayaprakash, M. S., Gangadhar, B. N., Girish, K., et al (1997) Prolonged seizures during electroconvulsive therapy. NIMHANS Journal, 15, 139–142.Google Scholar
McReadie, R. G., Phillips, K., Robinson, A. D. T., et al (1989) Is electroencephalographic monitoring of electroconvulsive therapy clinically useful? British Journal of Psychiatry, 154, 229–231.Google Scholar
Royal College of Psychiatrists (1995) The ECT Handbook. The 2nd Report of the Royal College of Psychiatrists' Special Committee on ECT. Council Report CR39. London: Gaskell.Google Scholar
Scott, A. I. F., Shering, P. A. & Dykes, S. (1989) Would monitoring by electroencephalogram improve the practice of electroconvulsive therapy? British Journal of Psychiatry, 154, 853–857.Google Scholar
Weiner, R. D., Coffey, C. E. & Krystal, A. D. (1991) Monitoring and management of electrically induced seizures. Psychiatric Clinics of North America, 14, 845–849.Google Scholar
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