A Naturalistic Study of the Measurement of Seizure Adequacy in Electroconvulsive Therapy

Abstract

The use of the rating scale has the potential to help clinicians optimize ECT. While not perfect in any sense, it still gives clinicians good predictive qualities when used as a clinical guide. It is important that larger studies look at all the potential variables that may interact with seizure adequacy and clinical outcome.

ECT Anesthesia: The Lighter the Better?

“…As hypothesized, pre-ictal BIS was significantly correlated with ictal parameters (i. e. motor response time, seizure concordance, ictal coherence) which are known to associate with better clinical outcome [6,8,11,12,16,19,21]. We replicated the findings of our preceding pilot study where pre-ictal BIS was correlated with identical ictal EEG parameters [25].…”

“…The aim of our study was to quantify the depth of anesthesia just before the application of electroconvulsive treatment to study the impact on the induced seizure and its ''effectiveness'' or ''adequacy'' [6]. As an outcome parameter we used the number of ECT sessions individually needed to reach a state of remission.…”

Factors Predicting Ictal Quality in Bilateral Electroconvulsive Therapy Sessions

“…First, EEG characteristics can predict the response to ECT [17]. Postictal suppression [18,19], ictal amplitude measures [8,20], and seizure quality scales correlated with symptomatology improvements [21]. Some seizure quality scales combining different indexes were also useful as predictors of ECT response [22,23].…”

Preliminary evaluation of clinical outcome and safety of ketamine as an anesthetic for electroconvulsive therapy in schizophrenia

“…Hence we hypothesize ketamine to be a suitable narcotic for schizophrenic patients admitted to ECT. We further hypothesize ketamine to display seizure quality, and thus, treatment effi cacy (Krystal et al 1995;Nobler et al 2000;Edwards et al 2003;Perera et al 2004;Sartorius et al 2006;Bundy et al 2010). Hence some authors consider the switch to ketamine anaesthesia in ECT as an augmentation strategy when it is not possible to adequately induce seizures with narcotics possessing anticonvulsant properties otherwise (Loo et al 2009(Loo et al , 2010.…”