Can Propofol Lead to an Increase in Seizure Threshold Over the Course of Electroconvulsive Therapy?

Abstract

ObjectiveTo evaluate the effects of 2 different dose regimens of propofol (low dose: < 1 mg/kg, high dose: ≥ 1 mg/kg) on the duration of the seizures, the required energy for the seizures, and the seizure threshold over the course of electroconvulsive therapy (ECT).MethodsThe electronic medical records of 165 patients receiving 971 sessions of ECT were analyzed retrospectively. Patients were evaluated in two groups according to the according to propofol doses that they had received for ECT. Group LP (n = 91): patients who received low dose propofol (< 1 mg/kg). Group HP (n = 74): patients who received high dose propofol (≥1 mg/kg).ResultsThe required energy for seizures in Group HP were significantly higher than the Group LP in the 3rd, 4th, 5th, 6th, 7th, 8th, and 9th sessions (p < 0.05). The duration of seizures in the Group HP were significantly lower than the Group LP in the 1st, 2nd, 4th, 5th, 7th, and 8th sessions (p < 0.05). Higher electrical stimulus was needed to acquire a minimum length of seizure (> 25 sn) during the course of ECT in higher propofol doses. Although there was an increase in the seizure threshold over the course of ECT in both groups, this increase was found to be much more pronounced in the high-dose propofol group according to the low-dose propofol group. Longer duration of seizures was observed in the low-dose propofol group.ConclusionHigher doses of propofol in induction of anesthesia can lead to a more progressive rise in seizure threshold than lower doses of propofol.

Ictal Electroencephalogram Visual Pattern Recognition of Seizure Adequacy During Electroconvulsive Therapy Treatment: A Step-by-Step Approach

“…Despite the artefacts’ appearance in a real clinical setting, the ability to correctly read the ECT-EEG tracings based on the operational criteria is invariably integral in ECT procedures. Whether the tracings are from the same or different patients, it is important for ECT practitioners to be aware that the determinants of the seizure threshold (and thus the tracing quality) in each patient are multifactorial and may change throughout the course of ECT—for example, the use of concurrent medication regimes that may differ from one treatment session to another, changes in the treatment session interval, any electrolyte imbalance or changes in oxygen or carbon dioxide blood levels ( 14 – 17 ).…”

Comparison of the target-controlled infusion and the manual infusion of propofol anesthesia during electroconvulsive therapy: an open-label randomized controlled trial

“…Such potential inferiority in efficacy in the TCI group might be explained by higher doses of propofol as well as higher predicted blood levels of propofol in the TCI group. Propofol has anticonvulsant properties, and a higher dose of propofol may impede the elicitation of seizures by ECT [30]. As regards significant interaction between TCI and ECT treatment number in seizure adequacy, the TCI and MI groups crossed approximately at the seventh treatment of ECT.…”

Various Psychiatric Manifestation in DiGeorge Syndrome (22q11.2 Deletion Syndrome): A Case Report

“…The combined effects of those factors might have an great influence on dopamine levels in DiGeorge syndrome with the defect of COMT gene. These aspects might be related to the fluctuation of DA level fluctuation and the change of sensitivity to antipsychotics [19,20].…”